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Backman C, Vaillancourt E, Chabot C, Joanisse J. Description of a Nurse Practitioner-Led Orthogeriatric Model of Care: A Health Record Review. Orthop Nurs 2024; 43:262-269. [PMID: 39321435 DOI: 10.1097/nor.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2024] Open
Abstract
Older adults often present with multiple comorbidities and face significant postoperative complications. This study aimed to describe the role of Nurse Practitioner (NP)-led orthogeriatric services in managing hip fracture patients. We conducted a review of health records of older adults with hip and proximal femoral fractures between July 2017 and June 2018, presenting descriptive statistics on patient characteristics, surgical outcomes, and the involvement of orthogeriatric services. A total of 197 participants were included, with a majority being female (n = 132; 67.0%). Most patients (53.8%; n = 106) had between five and nine pre-existing conditions. Among the 192 patients who underwent surgery, 69.8% (n = 134) experienced up to four surgical complications. The Nurse Practitioner provided care to 89.1% (n = 163) of the patients within the orthogeriatric service, with half of the patients (n = 82) requiring at least five NP interventions to manage complex pre- and postoperative needs. Refining the NP-led model could potentially help reduce the burden on physicians and surgeons in treating complex medical conditions, especially in settings where geriatricians may not be readily available.
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Affiliation(s)
- Chantal Backman
- Chantal Backman RN, MHA, PhD, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
- Emma Vaillancourt, RN, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
- Chantal Chabot, RN, MScN, NP, Hôpital Montfort, Ottawa, ON, Canada
- John Joanisse, MD, Institut du Savoir Montfort, Ottawa, ON, Canada; Hôpital Montfor, Ottawa, ON, Canada K1K 0T2
| | - Emma Vaillancourt
- Chantal Backman RN, MHA, PhD, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
- Emma Vaillancourt, RN, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
- Chantal Chabot, RN, MScN, NP, Hôpital Montfort, Ottawa, ON, Canada
- John Joanisse, MD, Institut du Savoir Montfort, Ottawa, ON, Canada; Hôpital Montfor, Ottawa, ON, Canada K1K 0T2
| | - Chantal Chabot
- Chantal Backman RN, MHA, PhD, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
- Emma Vaillancourt, RN, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
- Chantal Chabot, RN, MScN, NP, Hôpital Montfort, Ottawa, ON, Canada
- John Joanisse, MD, Institut du Savoir Montfort, Ottawa, ON, Canada; Hôpital Montfor, Ottawa, ON, Canada K1K 0T2
| | - John Joanisse
- Chantal Backman RN, MHA, PhD, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Bruyère Research Institute, Ottawa, ON, Canada
- Emma Vaillancourt, RN, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada
- Chantal Chabot, RN, MScN, NP, Hôpital Montfort, Ottawa, ON, Canada
- John Joanisse, MD, Institut du Savoir Montfort, Ottawa, ON, Canada; Hôpital Montfor, Ottawa, ON, Canada K1K 0T2
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Toledo D, Mayordomo-Cava J, Jurado P, Díaz A, Serra-Rexach JA. Trends in hip fracture rates in spain from 2001 to 2018. Arch Osteoporos 2024; 19:57. [PMID: 38958797 DOI: 10.1007/s11657-024-01406-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/24/2024] [Indexed: 07/04/2024]
Abstract
The present study includes the longest period of analysis with the highest number of hip fracture episodes (756,308) described in the literature for Spain. We found that the age-adjusted rates progressively decreased from 2005 to 2018. We believe that this is significant because it may mean that measures such as prevention and treatment of osteoporosis, or programs promoting healthy lifestyles, have had a positive impact on hip fracture rates. PURPOSE To describe the evolution of cases and rates of hip fracture (HF) in patients 65 years or older in Spain from 2001 to 2018 and examine trends in adjusted rates. METHODS Retrospective, observational study including patients ≥65 years with acute HF. Data from 2001 to 2018 were obtained from the Spanish National Record of the Minimum Basic Data Set of the Ministry of Health. We analysed cases of HF, crude incidence and age-adjusted rates by sex, length of hospital stay (LOS) and in-hospital mortality, and used joinpoint regression analysis to explore temporal trends. RESULTS We identified 756,308 HF cases. Mean age increased 2.5 years, LOS decreased 4.5 days and in-hospital mortality was 5.5-6.5%. Cases of HF increased by 49%. Crude rate per 100,000 was 533.3 (95% confidence interval [CI], 532.1-534.5), increasing 14.0% (95%CI, 13.7-14.2). Age-adjusted HF incidence rate increased by 6.9% from 2001 (535.7; 95%CI, 529.9-541.5) to 2005 (572.4; 95%CI, 566.7-578.2), then decreased by 13.3% until 2017 (496.1, 95%CI, 491.7-500.6). Joinpoint regression analysis indicated a progressive increase in age-adjusted incidence rates of 1.9% per year from 2001 to 2005 and a progressive decrease of -1.1% per year from 2005 to 2018. A similar pattern was identified in both sexes. CONCLUSIONS Crude incidence rates of HF in Spain in persons ≥65 years from 2001 to 2018 have gradually increased. Age-adjusted rates show a significant increase from 2001 to 2005 and a progressive decrease from 2005 to 2018.
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Affiliation(s)
- D Toledo
- Department of Admissions and Clinical Documentation, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - J Mayordomo-Cava
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Institute for Health Research of the Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, Madrid, Spain
| | - P Jurado
- Department of Admissions and Clinical Documentation, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Díaz
- Preventive Medicine and Healthcare and Quality Improvement Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J A Serra-Rexach
- Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Institute for Health Research of the Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Biomedical Research Networking Centre on Frailty and Healthy Ageing, CIBERFES, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Isaac CJ, Moore L, Bérubé M, Belzile É, Malo C, Giroux M, Belcaid A, Abiala G, Trépanier D, Émond M, Dionne CE. Predictors of adverse outcomes in elders hospitalised for isolated orthopaedic trauma: a multicentre cohort study. Emerg Med J 2024; 41:168-175. [PMID: 38233107 DOI: 10.1136/emermed-2023-213088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Patients >64 years of age now represent more than 51% of injury hospitalisations in Canada. The tools used to identify older patients who could benefit the most from an interdisciplinary approach include complex parameters difficult to collect in the ED, which suggests that better tools with higher accuracy and using items that can be derived from routinely collected data are needed. We aimed to identify variables that are associated with adverse outcomes in older patients admitted to a trauma centre for an isolated orthopaedic injury. METHODS We conducted a multicentre retrospective cohort study between 1 April 2013 and 31 March 2019 on older patients hospitalised with a primary diagnosis of isolated orthopaedic injury (n=19 928). Data were extracted from the provincial trauma registry (Registre des traumatismes du Québec). We used multilevel logistic regression to estimate the associations between potential predictors and adverse outcomes (extended length of stay, mortality, complications, unplanned readmission and adverse discharge destination). RESULTS Increasing age, male sex, specific comorbidities, type of orthopaedic injuries, increasing number of comorbidities, severe orthopaedic injury, head injuries and admission in the year before the injury were all significant predictors of adverse outcomes. CONCLUSION We identified eight predictors of adverse outcomes in patients >64 years of age admitted to a trauma centre for orthopaedic injury. These variables could eventually be used to develop a clinical decision rule to identify elders who may benefit the most from interdisciplinary care.
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Affiliation(s)
- Chartelin Jean Isaac
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Lynne Moore
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Étienne Belzile
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
- Department of Orthopedic Surgery, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Christian Malo
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
- Department of Emergency Medicine and Family Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Marianne Giroux
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Amina Belcaid
- Institut National d'Excellence en Santé et en Services Sociaux du Québec, Québec City, Québec, Canada
| | - Godwill Abiala
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
- Institut National d'Excellence en Santé et en Services Sociaux du Québec, Québec City, Québec, Canada
| | - David Trépanier
- Department of Emergency Medicine and Family Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Marcel Émond
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
- Department of Emergency Medicine and Family Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Clermont E Dionne
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Centre de recherche du CHU de Québec-Université Laval, Québec City, Québec, Canada
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Gupta S, Walke L, Simone M, Michener A, Nembhard I. The perceived value of a geriatrics-surgery co-management program: Perspectives from three surgical specialties. J Am Geriatr Soc 2024; 72:48-58. [PMID: 37947016 DOI: 10.1111/jgs.18636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Geriatrics-surgery co-management (GSCM) programs have improved patient outcomes, but little is known about how they change care and whether their value varies by surgical specialty. We aimed to assess GSCM's effects as perceived by Orthopedic Trauma, Trauma, and Neurosurgery clinicians. METHODS We conducted a mixed-methods study utilizing electronic survey and virtual interviews at Penn Presbyterian Medical Center, an academic trauma center, in Philadelphia, PA. Participants included physicians, advanced practice providers, nurses, social workers, and case managers in the aforementioned specialties. Key measures were perspectives on value of GSCM, its facilitators, specialty most appropriate to manage specified medical issues, and factors affecting use. RESULTS Of 71 eligible clinicians, 45 (63%) completed the survey and 12 (21%) of 56 purposefully sampled for specialty-role diversity were interviewed. Clinicians across specialties valued GSCM highly and similarly for impact on personal management of older adults (grand mean [standard error, SE] = 4.33 [0.24] out of 5; p = 0.80 for specialty means comparisons), patient care (mean [SE] = 4.47 [0.21]; p = 0.27), patient outcomes (mean [SE] = 4.26 [0.22]; p = 0.51), and specialty overall (mean [SE] = 4.55 [0.23]; p = 0.25) but less so for knowledge growth (mean [SE] = 3.47 [0.29]; p = 0.11). Interviewees across specialties reported that value derived from improved understanding of patient history, management of complex medical conditions, goals of care support, communication with families, and patient discharge facilitation. Interviewees also agreed on program facilitators: aligned stakeholders, shared data-driven goals, champion/administrative support, continuity and availability of geriatricians, and thorough communication. Specialties differed on three issues: (1) who should manage some medical concerns; (2) whether GSCM makes their job easier (significantly easier for Orthopedic Trauma: mean [SE] = 4.75 [0.29] vs. Trauma: mean [SE] = 4.01 [0.19]; p = 0.05); and (3) whether GSCM increases coordination difficulty (more for Neurosurgery: mean [SE] = 2.18 [0.0.58] vs. Orthopedic Trauma: mean [SE] = 0.51 [0.42]; p = 0.03 and Trauma: mean [SE] = 0.89 [0.28]; p = 0.07). Orthopedic Trauma had the most positive impression of GSCM overall. CONCLUSIONS Clinicians across diverse surgical specialties valued GSCM. Hospitals considering implementation or expansion of GSCM should attend to identified facilitators and may need to tailor to specialty.
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Affiliation(s)
- Sonia Gupta
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Walke
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark Simone
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alyson Michener
- Division of Geriatric Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ingrid Nembhard
- The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Li Y, Dong B. Development and validation of risk prediction nomograms for acute respiratory failure in elderly patients with hip fracture. J Orthop Surg Res 2023; 18:899. [PMID: 38007467 PMCID: PMC10676597 DOI: 10.1186/s13018-023-04395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Hip fractures in the elderly often lead to acute respiratory failure, but there is currently no tool to assess the prognosis of such patients. This study aims to develop a risk prediction model for respiratory failure in these patients. METHODS A retrospective cross-sectional study was conducted using the Medical Information Mart for Intensive Care (MIMIC)-IV database, incorporating data from 3,266 patients with hip fractures aged over 55 years from 2008 to 2019. Data included demographic information, laboratory indicators, comorbidities, and treatment methods. Patients were divided into a training group (70%) and a validation group (30%). Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to select prognostic predictors, and a visualized nomogram model was constructed using multivariate logistic regression analysis. Model performance and clinical applicability were assessed. Statistical analyses were done using R4.2.2, with P < 0.05 deemed significant. RESULTS Seven key factors, including age, height, albumin, chloride, pneumonia, acute kidney injury (AKI), and heparin use, were associated with respiratory failure risk. The model demonstrated good performance with area under the curve (AUC) values of 0.77 and 0.73 in the training and validation sets, respectively. The calibration curve showed good agreement, and decision curve analysis (DCA) indicated the model's clinical benefit. CONCLUSIONS This risk prediction model can effectively predict respiratory failure in hip fracture patients, assisting clinicians in identifying high-risk individuals and providing evidence-based references for treatment strategies.
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Affiliation(s)
- Yue Li
- Pain ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China
| | - Bo Dong
- Pain ward of Rehabilitation Department, Honghui Hospital, Xi'an Jiaotong University, No. 555 Youyi East Road, Beilin District, Xi'an, 710054, Shaanxi Province, China.
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Fasanya C, Lee JJ, Caronia CG, Rothburd L, Japhe T, Hahn YH, Reci D, Eckardt P. The Impact of Screening for Perioperative ICU Admission in Geriatric Hip Fracture Patients: A Retrospective Analysis. Cureus 2023; 15:e49234. [PMID: 38143658 PMCID: PMC10739485 DOI: 10.7759/cureus.49234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Hip fracture patients are a subset of trauma patients with high peri-operative mortality. To mitigate the mortality risk, the use of predictive scoring systems (e.g., RSI or Nomograms) for risk stratification and monitoring of high-risk patients in the intensive care unit (ICU) has been proposed. Screening patients for ICU admission with relatively low-cost tools may achieve high-quality, low-cost care. The aim of this study was to assess the effectiveness and feasibility of screening postoperative hip fracture patients for ICU admission. METHODS This is a retrospective single-site study comparing two groups of patients, before and after implementation of a hip fracture postoperative screening intervention in a level 1 trauma center in the United States. All hip fracture patients > 55 years of age admitted to the hospital between January 2021 and May 2023 were included. Trauma team members assessed and screened patients postoperatively in the post-anesthesia care unit (PACU), ordering standardized tests, including laboratory tests, a chest x-ray, and electrocardiogram (EKG). Assessment of the effect of the intervention included a comparison of a number of major adverse events (MAEs), mortality, planned and unplanned ICU admissions, ICU length of stay (LOS), and hospital LOS between pre- and post-intervention groups. Propensity score (PS) estimates were used to compare outcomes between the matched participants in the sample. A predictive model for ICU admission for the overall sample was estimated, and discriminative ability was assessed with an area under the curve (AUC) receiver operator characteristics (ROC) analysis. Lastly, feasibility was assessed by compliance with screening intervention and charges per patient related to the intervention. RESULTS The sample consisted of 290 patients in the pre-intervention and 180 patients in the post-intervention groups, respectively, with a mean age of 81.4 ± (9.9) years. There was a significant increase (p<0.01) in planned ICU admissions (OR=2.387, 95% CI (1.430, 3.983)) after screening protocol implementation. There was no significant difference between the pre-intervention group and post-intervention group in the number of MAEs (p=0.392), mortality (p=0.591), ICU LOS (p=0.617), and hospital LOS (p=0.151). When the PS-matched sample (n=424) was analyzed, there was a significant decrease (p=0.45) in unplanned ICU admissions (OR=6.40, 95% CI (0.81, 50.95)) after protocol implementation. Anticoagulants, emergency department (ED) respiratory rate (RR), injury severity score (ISS), number of comorbidities, substance use disorder (SAD), peripheral artery disease (PAD), and chronic obstructive pulmonary disease (COPD) were significant predictors of ICU admission (p=0.002, 0.022, 0.030, 0.034, 0.039, 0.039, and 0.042), respectively, and, demonstrated the discriminative ability between high and low risk for ICU admission (AUC=0.597, 0.587, 0.581, 0.578, 0.513, and 0.587, respectively). The screening intervention was achievable with 99% compliance (Kappa estimate 0.94) among trauma team members with an average charge of $282 per patient. CONCLUSION The addition of a postoperative screening intervention for hip fracture patients > 55 years of age is achievable and decreases unplanned ICU admissions in matched samples. Presenting clinical indicators and comorbidities are associated with ICU admission and provide sufficient discriminatory ability as criteria for ICU admission.
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Affiliation(s)
| | - John J Lee
- Orthopaedic Surgery, Good Samaritan University Hospital, West Islip, USA
| | | | | | - Tenzing Japhe
- Trauma, New York Institute of Technology, West Islip, USA
| | - Young Hee Hahn
- Trauma, New York Institute of Technology, West Islip, USA
| | - Dajana Reci
- Trauma, New York Institute of Technology, West Islip, USA
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Gao F, Liu G, Ge Y, Tan Z, Chen Y, Peng W, Zhang J, Zhang X, He J, Wen L, Wang X, Shi Z, Hu S, Sun F, Gong Z, Sun M, Tian M, Zhu S, Yang M, Wu X. Orthogeriatric co-managements lower early mortality in long-lived elderly hip fracture: a post-hoc analysis of a prospective study. BMC Geriatr 2023; 23:571. [PMID: 37723423 PMCID: PMC10506232 DOI: 10.1186/s12877-023-04289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE To evaluate the clinical effectiveness of orthogeriatric co-management care in long-lived elderly hip fracture patients (age ≥ 90). METHODS Secondary analysis was conducted in long-lived hip fracture patients between 2018 to 2019 in 6 hospitals in Beijing, China. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With 30-day mortality as the primary outcome, multivariate regression analyses were performed after adjusting for potential covariates. 30-day mobility and quality of life were compared between groups. RESULTS A total of 233 patients were included, 223 of whom completed follow-up (125 in CM group, 98 in TC group). The average age was 92.4 ± 2.5 years old (range 90-102). The 30-day mortality in CM group was significantly lower than that in TC group after adjustments for (2.4% vs. 10.2%; OR = 0.231; 95% CI 0.059 ~ 0.896; P = 0.034). The proportion of patients undergoing surgery and surgery performed within 48 h also favored the CM group (97.6% vs. 85.7%, P = 0.002; 74.4% vs. 24.5%, P < 0.001; respectively). In addition, much more patients in CM group could walk with or without aids in postoperative 30 days than in the TC group (87.7% vs. 60.2%, P < 0.05), although differences were not found after 1-year follow-up. And there was no significant difference in total cost between the two groups (P > 0.05). CONCLUSIONS For long-lived elderly hip fracture patients, orthogeriatric co-management care lowered early mortality, improved early mobility and compared with the traditional consultation mode.
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Affiliation(s)
- Feng Gao
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Gang Liu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Yufeng Ge
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Zhelun Tan
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Yimin Chen
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Weidong Peng
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Jing Zhang
- School of Population Health, University of New South Wales, Sydney, NSW Australia
| | - Xinyi Zhang
- The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
| | - Jiusheng He
- Department of Orthopaedics, Beijing Shunyi District Hospital, Beijing, China
| | - Liangyuan Wen
- Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianhai Wang
- Department of Orthopaedics, Beijing Changping District Hospital, Beijing, China
| | - Zongxin Shi
- Department of Orthopaedics, Beijing Liangxiang Hospital, Beijing, China
| | - Sanbao Hu
- Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fengpo Sun
- Department of Orthopaedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zishun Gong
- Department of Orthopaedics, Beijing Liangxiang Hospital, Beijing, China
| | - Mingyao Sun
- Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Maoyi Tian
- School of Public Health, Harbin Medical University, Harbin, China
| | - Shiwen Zhu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Minghui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
| | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Peking University Fourth School of Clinical Medicine, Beijing, China
- National Center of Orthopaedics, Beijing, China
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8
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Meinig R, Jarvis S, Salottolo K, Nwafo N, McNair P, Harrison P, Morgan S, Duane T, Woods B, Nentwig M, Kelly M, Cornutt D, Bar-Or D. Propensity matched analysis examining the effect of passive reversal of direct oral anticoagulants on blood loss and the need for transfusions among traumatic geriatric hip fractures. Eur J Med Res 2023; 28:241. [PMID: 37475008 PMCID: PMC10360353 DOI: 10.1186/s40001-023-01053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/08/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Reversal of direct oral anticoagulants (DOACs) is currently recommended prior to emergent surgery, such as surgical intervention for traumatic geriatric hip fractures. However, reversal methods are expensive and timely, often delaying surgical intervention, which is a predictor of outcomes. The study objective was to examine the effect of DOAC reversal on blood loss and transfusions among geriatric patients with hip fractures. METHODS This retrospective propensity-matched study across six level I trauma centers included geriatric patients on DOACs with isolated fragility hip fractures requiring surgical intervention (2014-2017). Outcomes included: intraoperative blood loss, intraoperative pRBCs, and hospital length of stay (HLOS). RESULTS After matching there were 62 patients (31 reversed, 31 not reversed), 29 patients were not matched. The only reversal method utilized was passive reversal (waiting ≥ 24 hours for elimination). Passively reversed patients had a longer time to surgery (mean, 43 vs. 18 hours, p < 0.01). Most patients (92%) had blood loss (90% passively reversed, 94% not reversed); the median volume of blood loss was 100 mL for both those groups, p = 0.97. Thirteen percent had pRBCs transfused (13% passively reversed and 13% not reversed); the median volume of pRBCs transfused was 525 mL for those passively reversed and 314 mL for those not reversed, p = 0.52. The mean HLOS was significantly longer for those passively reversed (7 vs. 5 days, p = 0.001). CONCLUSIONS Passive DOAC reversal for geriatric patients with isolated hip fracture requiring surgery may be contributing to delayed surgery and an increased HLOS without having a significant effect on blood loss or transfusions. These data suggest that passive DOAC reversal may not be necessary prior to surgical repair of isolated hip fracture.
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Affiliation(s)
- Richard Meinig
- Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO, 80907, USA
| | - Stephanie Jarvis
- Injury Outcomes Network (ION) Research, 501 East Hampden Ave, Englewood, CO, 80113, USA
| | - Kristin Salottolo
- Injury Outcomes Network (ION) Research, 501 East Hampden Ave, Englewood, CO, 80113, USA
| | - Nnamdi Nwafo
- Swedish Medical Center, 501 East Hampden Ave, Englewood, CO, 80113, USA
| | - Patrick McNair
- St. Anthony Hospital, 11600 W 2nd Plaza, Lakewood, CO, 80228, USA
| | - Paul Harrison
- Wesley Medical Center, 550 North Hillside St. Wichita, Wichita, KS, 67214, USA
| | - Steven Morgan
- Swedish Medical Center, 501 East Hampden Ave, Englewood, CO, 80113, USA
| | - Therese Duane
- Medical City Plano, 3901 West 15th Street, Plano, TX, 75075, USA
| | - Bradley Woods
- Research Medical Center, 2316 East Meyer Blvd, Kansas City, MO, 64132, USA
| | - Michelle Nentwig
- Wesley Medical Center, 550 North Hillside St. Wichita, Wichita, KS, 67214, USA
| | - Michael Kelly
- Penrose Hospital, 2222 N Nevada Ave, Colorado Springs, CO, 80907, USA
| | - David Cornutt
- Regional West Medical Center, 4021 Ave B, Scottsbluff, NE, 69361, USA
| | - David Bar-Or
- Injury Outcomes Network (ION) Research, 501 East Hampden Ave, Englewood, CO, 80113, USA.
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9
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Fokin AA, Wycech Knight J, Darya M, Stalder R, Puente I, Weisz RD. Two surgical pathways for isolated hip fractures: A comparative study. World J Orthop 2023; 14:399-410. [PMID: 37377993 PMCID: PMC10292054 DOI: 10.5312/wjo.v14.i6.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/22/2023] [Accepted: 04/27/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Hip fractures (HF) are common among the aging population, and surgery within 48 h is recommended. Patients can be hospitalized for surgery through different pathways, either trauma or medicine admitting services.
AIM To compare management and outcomes among patients admitted through the trauma pathway (TP) vs medical pathway (MP).
METHODS This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures (AO/Orthopedic Trauma Association Type 31) who underwent surgery at a level 1 trauma center between 2016-2021. There were 69 patients admitted through the TP and 2025 admitted through the MP. To ensure comparability between groups, 66 of the 2025 MP patients were propensity matched to 66 TP patients by age, sex, HF type, HF surgery, and American Society of Anesthesiology score. The statistical analyses included multivariable analysis, group characteristics, and bivariate correlation comparisons with the χ² test and t-test.
RESULTS After propensity matching, the mean age in both groups was 75-years-old, 62% of both groups were females, the main HF type was intertrochanteric (TP 52% vs MP 62%), open reduction internal fixation was the most common surgery (TP 68% vs MP 71%), and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP. The majority of patients in TP and MP (71% vs 74%) were geriatric (≥ 65-years-old). Falls were the main mechanism of injury in both groups (77% vs 97%, P = 0.001). There were no significant differences in pre-surgery anticoagulation use (49% vs 41%), admission day of the week, or insurance status. The incidence of comorbidities was equal (94% for both) with cardiac comorbidities being dominant in both groups (71% vs 73%). The number of preoperative consultations was similar for TP and MP, with the most common consultation being cardiology in both (44% and 36%). HF displacement occurred more among TP patients (76% vs 39%, P = 0.000). Time to surgery was not statistically different (23 h in both), but length of surgery was significantly longer for TP (59 min vs 41 min, P = 0.000). Intensive care unit and hospital length of stay were not statistically different (5 d vs 8 d and 6 d for both). There were no statistical differences in discharge disposition and mortality (3% vs 0%).
CONCLUSION There were no differences in outcomes of surgeries between admission through TP vs MP. The focus should be on the patient’s health condition and on prompt surgical intervention.
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Affiliation(s)
- Alexander A Fokin
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Joanna Wycech Knight
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
| | - Maral Darya
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Ryan Stalder
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
| | - Ivan Puente
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
- Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
- Department of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, United States
| | - Russell D Weisz
- Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
- Department of Orthopedics, South Palm Orthopedics, Delray Beach, FL 33445, United States
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10
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Optimal Management of the Geriatric Trauma Patient. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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11
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Hsu YF, Chou FH, Wang HH, Chu YC, Liao KL. Effectiveness of integrated care for elderly patients with hip fractures: A systematic review and meta-analysis. Geriatr Nurs 2023; 49:65-73. [PMID: 36446147 DOI: 10.1016/j.gerinurse.2022.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
Hip fractures in the elderly often cause many complications after surgery. Although ample evidence shows that integrated care can effectively improve postoperative conditions, the effectiveness of specific interventions remains inconsistent across studies. This study was conducted following the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The database was from November 1998 to July 2022. Twelve studies (3,010 participants) implemented integrated care for elderly patients with hip fractures. Overall, integrated care improved Activities of Daily Living (ADL) levels within 6 months, at 12 months, Quality of Life (QoL) at 6 months, and decreased Length of Stay (LOS) and mortality rate at 3 months. At least 3 months of integrated care intervention for hip fractures in the elderly to reduce patient complications and medical costs, can be used as a reference for future policies and clinical care.
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Affiliation(s)
- Yi-Fen Hsu
- College of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan.
| | - Yi-Chin Chu
- College of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan; Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuei-Lin Liao
- College of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan; Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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12
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Su SF, Lin SN. Effects of comprehensive geriatric care on depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence in older persons receiving hip-fracture surgery: A meta-analysis. Int J Nurs Pract 2022; 28:e13099. [PMID: 35978458 DOI: 10.1111/ijn.13099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 06/04/2022] [Accepted: 07/23/2022] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence of comprehensive geriatric care in patients receiving hip-fracture surgery. BACKGROUND Hip fractures among older persons result in restricted activities of daily living, longer hospital stays, frequent emergency department visits and re-presentation to hospital, which may increase depressive symptoms and death risk. The benefits of comprehensive geriatric care have not been determined. DESIGN A five-step Cochrane collaboration meta-analysis was used. DATA SOURCES Randomized controlled trials published from 1980 to 2020 in which comprehensive geriatric care was provided following hip-fracture surgery were retrieved from the Cochrane Library, Clinical Key, Embase, MEDLINE, OVID and PubMed databases. Indicators were depressive symptoms, emergency department visits, re-hospitalization and discharge to the same residence. REVIEW METHODS The Group Reading Assessment, Risk of Bias 2.0 tool, modified Jadad scale and Comprehensive Meta-Analysis Version 3 software were used. RESULTS Overall, 1291 patients from six randomised controlled trials were included. Comprehensive geriatric care improved depressive symptoms and lowered emergency department visits but did not improve re-hospitalization rates or discharge to the same residence. CONCLUSION Comprehensive geriatric care should include depression management and individualized care plans. Further depression-related studies are required to verify their benefits.
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Affiliation(s)
- Shu-Fen Su
- Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan
| | - Shu-Ni Lin
- Department of Nursing, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
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13
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Rhodes H, Coile E, Eversley-Kelso T, Shaw E, Harton R, Dunne J, Pepe A. Isolated Hip Fractures in the Elderly: Best Practice Analysis of Perioperative Medical Optimization Including Effect of Comorbidities, Functional Status, and Demographics. Am Surg 2022; 88:1943-1945. [PMID: 35487500 DOI: 10.1177/00031348221091952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Isolated hip fractures (IHFs) contribute to functional decline in the elderly. Our purpose was to evaluate IHF at two level 1 trauma centers and the effect of comorbidities on length of stay (LOS), ICU admission, disposition, and mortality. A retrospective study from July 2016 through December 2020 including patients ≥65 with IHFs identified 785 patients. Prior dependent functional status yielded a longer LOS (>6 days vs <6 days, P = .01). Comorbidities were not associated with increased LOS or ICU admission. ICU admission rate was 12.75%. Patients with advanced directive had increased ICU admission (8% vs 3%). The mortality rate was 2%. Increased mortality was seen with advanced directives (17% vs 2%, P < .05) and cirrhosis/substance abuse (12% vs 2%, P < .05). Disposition included home (20%), rehabilitation (43%), and SNF (31%). Comorbidities did not affect ICU admission, LOS, or disposition; however, cirrhosis/substance abuse demonstrated increased mortality.
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Affiliation(s)
- Heather Rhodes
- 23765Grand Strand Regional Medical Center, Myrtle Beach, SC, USA
| | - Evelyn Coile
- 7240Memorial Health University Medical Center, Savannah, GA, USA
| | | | - Eric Shaw
- 7240Memorial Health University Medical Center, Savannah, GA, USA
| | - Robert Harton
- 23765Grand Strand Regional Medical Center, Myrtle Beach, SC, USA
| | - James Dunne
- 7240Memorial Health University Medical Center, Savannah, GA, USA
| | - Antonio Pepe
- 23765Grand Strand Regional Medical Center, Myrtle Beach, SC, USA
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14
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Yee DKH, Lau TW, Fang C, Ching K, Cheung J, Leung F. Orthogeriatric Multidisciplinary Co-Management Across Acute and Rehabilitation Care Improves Length of Stay, Functional Outcomes and Complications in Geriatric Hip Fracture Patients. Geriatr Orthop Surg Rehabil 2022; 13:21514593221085813. [PMID: 35433103 PMCID: PMC9006372 DOI: 10.1177/21514593221085813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction As the global number of geriatric hip fracture cases continues to proliferate, a newly developed orthogeriatric co-management multidisciplinary care model has been implemented since November 2018 to meet further increases in demand. Our objective was to evaluate the effectiveness of the new pathway in improving the clinical outcomes of fragility hip fractures. Methods The data of geriatric hip fracture patients from 1 April 2018 till 30 October 2018 was collected as the conventional orthopaedic care model (pre-orthogeriatric care model) to compare with data from the orthogeriatric co-management model, 1 Feb 2019 till 31 August 2019. Clinical outcomes were analyzed between the groups, with the efficiency of the programme reflected in the total length of stay in acute and convalescent hospitals. Results 194 patients were recruited to the conventional group and 207 were recruited to the orthogeriatric group, 290 patients (72.3%) were female. The mean (SD) patient age was 84.2 (7.9) years. The median length of stay in the acute and rehabilitation hospitals decreased by 1 day and 2 days, respectively (P=.001). The orthogeriatric group was associated with a higher Modified Barthel Index score on discharge from the rehabilitation hospital and more patients in the orthogeriatric collaboration group received osteoporosis medication prescription within one year after the index fracture. There was no difference in the 28-days unplanned readmission rate, complication rate, mortality rate or Elderly Mobility Scale scores on discharge from the rehabilitation hospital between the two groups. Conclusion Orthogeriatric collaboration has been proven to be effective in terms of a decreased length of stay in both the acute and the rehabilitation hospitals.
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Affiliation(s)
- Dennis King Hang Yee
- The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Tak-Wing Lau
- The Unviersity of Hong Kong, Pokfulam, Hong Kong
| | | | - Kathine Ching
- The University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
| | - Jake Cheung
- The Unviersity of Hong Kong, Pokfulam, Hong Kong
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15
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Van Heghe A, Mordant G, Dupont J, Dejaeger M, Laurent MR, Gielen E. Effects of Orthogeriatric Care Models on Outcomes of Hip Fracture Patients: A Systematic Review and Meta-Analysis. Calcif Tissue Int 2022; 110:162-184. [PMID: 34591127 PMCID: PMC8784368 DOI: 10.1007/s00223-021-00913-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/06/2021] [Indexed: 10/24/2022]
Abstract
Orthogeriatrics is increasingly recommended in the care of hip fracture patients, although evidence for this model is conflicting or at least limited. Furthermore, there is no conclusive evidence on which model [geriatric medicine consultant service (GCS), geriatric medical ward with orthopedic surgeon consultant service (GW), integrated care model (ICM)] is superior. The review summarizes the effect of orthogeriatric care for hip fracture patients on length of stay (LOS), time to surgery (TTS), in-hospital mortality, 1-year mortality, 30-day readmission rate, functional outcome, complication rate, and cost. Two independent reviewers retrieved randomized controlled trials, controlled observational studies, and pre/post analyses. Random-effects meta-analysis was performed. Thirty-seven studies were included, totaling 37.294 patients. Orthogeriatric care significantly reduced LOS [mean difference (MD) - 1.55 days, 95% confidence interval (CI) (- 2.53; - 0.57)], but heterogeneity warrants caution in interpreting this finding. Orthogeriatrics also resulted in a 28% lower risk of in-hospital mortality [95%CI (0.56; 0.92)], a 14% lower risk of 1-year mortality [95%CI (0.76; 0.97)], and a 19% lower risk of delirium [95%CI (0.71; 0.92)]. No significant effect was observed on TTS and 30-day readmission rate. No consistent effect was found on functional outcome. Numerically lower numbers of complications were observed in orthogeriatric care, yet some complications occurred more frequently in GW and ICM. Limited data suggest orthogeriatrics is cost-effective. There is moderate quality evidence that orthogeriatrics reduces LOS, in-hospital mortality, 1-year mortality, and delirium of hip fracture patients and may reduce complications and cost, while the effect on functional outcome is inconsistent. There is currently insufficient evidence to recommend one or the other type of orthogeriatric care model.
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Affiliation(s)
| | - Gilles Mordant
- Institute of Statistics, Biostatistics and Actuarial Sciences, UCLouvain, Louvain-la-Neuve, Belgium
| | - Jolan Dupont
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marian Dejaeger
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michaël R Laurent
- Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium
- Geriatrics Department, Imelda Hospital, Bonheiden, Belgium
| | - Evelien Gielen
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
- Centre for Metabolic Bone Diseases, UZ Leuven, Leuven, Belgium.
- Department of Geriatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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16
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Significant variations in preoperative fluid resuscitation volumes delivered to elderly hip fracture patients at six level 1 trauma centers: an observational descriptive study. OTA Int 2022; 5:e162. [PMID: 34984321 PMCID: PMC8716099 DOI: 10.1097/oi9.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 09/22/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
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17
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Li XP, Zhang P, Zhu SW, Yang MH, Wu XB, Jiang XY. All-cause mortality risk in aged femoral intertrochanteric fracture patients. J Orthop Surg Res 2021; 16:727. [PMID: 34930355 PMCID: PMC8686562 DOI: 10.1186/s13018-021-02874-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/05/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures. Aim This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics. Materials and methods This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2–3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality. Results (1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation). Conclusion Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed.
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Affiliation(s)
- Xin-Ping Li
- Department of Geriatrics, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| | - Ping Zhang
- Department of Geriatrics, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| | - Shi-Wen Zhu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| | - Ming-Hui Yang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China.
| | - Xin-Bao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
| | - Xie-Yuan Jiang
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, China
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18
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Morrison CA, Morrison MM. For you were hungry and I gave you food: The prevalence and treatment of malnutrition in patients with acute hip fracture. Nutr Clin Pract 2021; 37:59-67. [PMID: 34897820 DOI: 10.1002/ncp.10809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Hip fractures are a common clinical problem with substantial morbidity and difficult recovery. Preexisting malnutrition has been shown to be common in those patients and a substantial risk factor for poorer outcomes, increased length of stay, and mortality. Additionally, great variability exists in reported malnutrition prevalence rates owing to the variety of nutrition screening and assessment tools utilized globally to identify malnutrition in these patients. Although previous data and a recent Cochrane review have not proven the value of nutrition supplements, we highlight several articles that show an opportunity for improvement in the nutrition care of patients sustaining hip fractures along with a multicenter randomized trial demonstrating the value of carefully designed nutrition intervention. There is also evidence that malnourished patients with hip fracture are still being undertreated. Current guidelines are reviewed, and continued efforts on the part of the clinicians to follow the guidelines as well as lowering the barriers to high-quality nutrition research is discussed.
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Affiliation(s)
- Chet A Morrison
- Department of Surgery, Central Michigan University, Saginaw, Michigan, USA
| | - Maya M Morrison
- Worldwide Medical Affairs, Clinical Nutrition, Baxter Healthcare, Deerfield, Illinois, USA
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In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU® Geriatric Trauma Centre. Medicina (B Aires) 2021; 57:medicina57111197. [PMID: 34833415 PMCID: PMC8617676 DOI: 10.3390/medicina57111197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: The implementation of orthogeriatric co-management (OGCM) reflects the demand for interdisciplinary collaborations due to the increasing comorbidities of geriatric trauma patients. This study aimed to assess clinical in-hospital outcomes in lumbar spine, thoracic spine, and pelvic ring fragility fracture patients before and after the implementation of a Geriatric Trauma Centre (GTC) certified by the German Trauma Society (DGU®). Materials and Methods: In this observational, retrospective cohort study, geriatric trauma patients (>70 years of age) were stratified into either a pre-GTC group (hospital admission between 1 January 2012 and 31 December 2013) or a post-GTC group (hospital admission between 1 January 2017 and 31 December 2018). Patients’ pre-injury medical complexity was measured by ASA class (American Society of Anaesthesiologists classification), the use of anticoagulant medication, and the ACCI (Age-adjusted Charlson Comorbidity Index). Outcome parameters were patients’ in-hospital length of stay (LOS) and mortality rates, as well as new in-hospital findings and diagnoses. Further, the necessity of deviation from initial management plans due to complications was assessed using the Adapted Clavien–Dindo Scoring System in Trauma (ACDiT score of ≥1). Results: Patients in the post-GTC group (n = 111) were older (median age 82.0 years) compared to the pre-GTC group (n = 108, median age 80.0 years, p = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all p > 0.05). Patients in the post-GTC group used vitamin K antagonists or direct oral anticoagulants more frequently (21.3% versus 10.8%). The incidence of non-surgical treatment and mortality was comparable between groups, while LOS tended to be shorter in the post-GTC group (7.0 days versus 9.0 days, p = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, p = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, p = 0.094), while an ACDiT score of ≥1 was comparable between groups (p = 0.169). Conclusions: In this study including lumbar spine, thoracic spine, and pelvic ring geriatric fragility fractures, patients in the post-GTC group were more medically complex. More UTIs and the tendency for increased delirium detection was observed in the post-GTC group, likely due to improved diagnostic testing. Nonetheless, the necessity of deviation from initial management plans (ACDiT score of ≥1) was comparable between groups, potentially a positive result of OGCM.
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2021; 33:2405-2443. [PMID: 34287785 DOI: 10.1007/s40520-021-01898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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Bardes JM, Grabo DJ, Donovan J, Albuquerque A, Coleman KC, Wen S, Wilson A, Nguyen J, Bardes A. Half of geriatric trauma patients have significant ocular disease: Findings of a novel trauma provider eye examination for vision screening. J Trauma Acute Care Surg 2021; 91:148-153. [PMID: 34144562 PMCID: PMC8243858 DOI: 10.1097/ta.0000000000003156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Geriatric ground level fall is a common admission diagnosis for trauma centers in the United States. Visual health has been linked to fall risk reduction in older adult but is rarely fully evaluated during a trauma admission. Using a commercial application and a questionnaire, we developed and tested a trauma provider eye examination (TPEE) to screen visual health. This study used the TPEE to (1) evaluate the prevalence of undiagnosed or undertreated visual disease in geriatric trauma patients and (2) determine the feasibility and reliability of the TPEE to screen for vision disease. METHODS This prospective study included patients older than 60 years evaluated by the trauma service from June 2019 to May 2020. Patients with ocular or globe trauma were excluded. The primary outcome was significant abnormal vision (SAV) found using the TPEE. Ophthalmology performed a dilated examination as the criterion standard for comparison. We assessed the feasibility and reliability of the TPEE. Fisher's exact test and logistic model were used in the data analysis. RESULTS Enrollment concluded with 96 patients. Mean age was 75 years, and fall (79%) was the most common mechanism of injury. Significant abnormal vision was common: undiagnosed disease was found in 39% and undertreated in 14%. Trauma provider examination was 94% sensitive and 92% specific for SAV cases. Congruence between TPEE and ophthalmology examination was highest in pupil examination (86%), visual fields (58%), and Amsler grid (52%). Multivariate analysis found that a combination of an abnormal Amsler test and abnormal visual field defect was significantly associated with SAV (odds ratio, 4.1; p = 0.03). CONCLUSION Trauma provider eye examination screening can identify patients with visual deficits. Given the association between visual deficits and fall risk, older adults may benefit from such a screening or a formal ophthalmology referral. LEVEL OF EVIDENCE Therapeutic/Care Management, level II.
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Affiliation(s)
- James M Bardes
- From the Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery (J.M.B., D.J.G., K.C.C., A.W.), West Virginia University; West Virginia University School of Medicine (J.D.); West Virginia University Health Sciences Research and Graduate Education (A.A.); Division of Biostatistics (S.W.), West Virginia University School of Public Health; and Department of Ophthalmology (J.N., A.B.), West Virginia University, Morgantown, West Virginia
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A bibliometric analysis of orthogeriatric care: top 50 articles. Eur J Trauma Emerg Surg 2021; 48:1673-1682. [PMID: 34114053 PMCID: PMC9192394 DOI: 10.1007/s00068-021-01715-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/26/2021] [Indexed: 11/22/2022]
Abstract
Background Population is ageing and orthogeriatric care is an emerging research topic. Purpose This bibliometric review aims to provide an overview, to investigate the status and trends in research in the field of orthogeriatric care of the most influential literature. Methods From the Core Collection databases in the Thomson Reuters Web of Knowledge, the most influential original articles with reference to orthogeriatric care were identified in December 2020 using a multistep approach. A total of 50 articles were included and analysed in this bibliometric review. Results The 50 most cited articles were published between 1983 and 2017. The number of total citations per article ranged from 34 to 704 citations (mean citations per article: n = 93). Articles were published in 34 different journals between 1983 and 2017. In the majority of publications, geriatricians (62%) accounted for the first authorship, followed by others (20%) and (orthopaedic) surgeons (18%). Articles mostly originated from Europe (76%), followed by Asia–pacific (16%) and Northern America (8%). Key countries (UK, Sweden, and Spain) and key topic (hip fracture) are key drivers in the orthogeriatric research. The majority of articles reported about therapeutic studies (62%). Conclusion This bibliometric review acknowledges recent research. Orthogeriatric care is an emerging research topic in which surgeons have a potential to contribute and other topics such as intraoperative procedures, fractures other than hip fractures or elective surgery are related topics with the potential for widening the field to research.
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Rocha-Romero A, Arias-Mejia K, Salas-Ruiz A, Peng PWH. Pericapsular nerve group (PENG) block for hip fracture in the emergency department: a case series. Anaesth Rep 2021; 9:97-100. [PMID: 34027410 DOI: 10.1002/anr3.12118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 12/16/2022] Open
Abstract
Guidelines for the management of hip fractures recommend timely identification, analgesia and optimisation, in order to facilitate prompt surgical repair. In achieving these aims, multidisciplinary care is essential. In this case series, we present five patients who received bedside pericapsular nerve group (PENG) blocks by emergency physicians in collaboration with the anaesthesia team for pain management following hip fracture. The PENG block is a novel motor- and opioid-sparing technique, which offers long-lasting analgesia and requires less volume than other blocks. In all of the cases in this series, the blocks were performed successfully in a short period of time, without complication. All patients reported a clinically important reduction in pain scores. Patients with hip fracture are often medically complex, and while early surgery is not always possible, pain management should be addressed from an early point in their hospital admission. Multidisciplinary input into peri-operative pathways can enhance the provision of analgesia in the emergency department, by allowing anaesthetists and emergency physicians to work together for the benefit of these often-frail patients.
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Affiliation(s)
- A Rocha-Romero
- Department of Anaesthesia and Pain Medicine Hospital de Trauma Centro Nacional de Rehabilitación San José Costa Rica
| | - K Arias-Mejia
- Department of Emergency Medicine Hospital San Vicente de Paúl Heredia Costa Rica
| | - A Salas-Ruiz
- Department of Emergency Medicine Hospital San Vicente de Paúl Heredia Costa Rica
| | - P W H Peng
- Department of Anaesthesiology and Pain Management University Health Network University of Toronto Canada
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Lee JC, Koo K, Wong EKC, Naqvi R, Wong CL. Impact of an orthogeriatric collaborative care model for older adults with hip fracture in a community hospital setting. Can J Surg 2021; 64:E211-E217. [PMID: 33769005 PMCID: PMC8064250 DOI: 10.1503/cjs.001720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Studies have shown that the incidence of postoperative delirium, the hospital length of stay and time to surgery are reduced when older adults with a hip fracture are cared for by a multidisciplinary team providing comprehensive geriatric assessments. Most of these studies have been conducted in academic centres. We sought to determine if implementation of an orthogeriatric collaborative care model would improve key quality of care metrics in a community hospital setting. Methods This retrospective pre- and postintervention single-site study was conducted in a community hospital in Ontario, Canada. We included consecutive patients aged 65 years or older who were admitted for a hip fracture between June 2015 and June 2017. In the intervention period, a new postoperative order set included a referral to a geriatrician for comprehensive geriatric assessment, with direct implementation of recommendations. Primary outcomes were the incidence of postoperative delirium and length of stay. Secondary outcomes included Health Quality Ontario’s quality standards for hip fracture. Results A total of 212 consecutive patients (95 in the preintervention group and 117 in the postintervention group) were included in the study. The incidence of postoperative delirium (26.3% v. 26.5%, p = 0.98) and length of stay (interquartile range 4–10 v. 5–10 d, p = 0.32) were similar in the preintervention and postintervention groups. There were improvements (p < 0.001) in the rates of asssessment of mental status, falls and bone health; identification of delirium prevention strategies; prescription of vitamin D or calcium or both; and recommendations for antiresorptive therapy. Despite systemic implementation of the orthogeriatric model, only 74.4% of patients in the postintervention group were seen by a geriatric medicine consultant. Conclusion Although the implementation of an orthogeriatric collaborative care model for older adults with a hip fracture did not reduce the incidence of postoperative delirium or length of stay, there were improvements in the rates at which several other key quality standards for hip fracture care were met. Earlier proactive, comprehensive geriatric assessment in a community hospital setting will be the target for further quality improvement initiatives.
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Affiliation(s)
- Janice C Lee
- From the University of Toronto, Toronto, Ont. (Lee, E.K.C. Wong, C.L. Wong); the Markham Stouffville Hospital, Markham, Ont. (Koo, Naqvi); Unity Health, Toronto, Ont. (E.K.C. Wong, C.L. Wong); and the Li Ka Shing Knowledge Institute, Toronto, Ont. (E.K.C. Wong, C.L. Wong)
| | - Kevin Koo
- From the University of Toronto, Toronto, Ont. (Lee, E.K.C. Wong, C.L. Wong); the Markham Stouffville Hospital, Markham, Ont. (Koo, Naqvi); Unity Health, Toronto, Ont. (E.K.C. Wong, C.L. Wong); and the Li Ka Shing Knowledge Institute, Toronto, Ont. (E.K.C. Wong, C.L. Wong)
| | - Eric K C Wong
- From the University of Toronto, Toronto, Ont. (Lee, E.K.C. Wong, C.L. Wong); the Markham Stouffville Hospital, Markham, Ont. (Koo, Naqvi); Unity Health, Toronto, Ont. (E.K.C. Wong, C.L. Wong); and the Li Ka Shing Knowledge Institute, Toronto, Ont. (E.K.C. Wong, C.L. Wong)
| | - Raza Naqvi
- From the University of Toronto, Toronto, Ont. (Lee, E.K.C. Wong, C.L. Wong); the Markham Stouffville Hospital, Markham, Ont. (Koo, Naqvi); Unity Health, Toronto, Ont. (E.K.C. Wong, C.L. Wong); and the Li Ka Shing Knowledge Institute, Toronto, Ont. (E.K.C. Wong, C.L. Wong)
| | - Camilla L Wong
- From the University of Toronto, Toronto, Ont. (Lee, E.K.C. Wong, C.L. Wong); the Markham Stouffville Hospital, Markham, Ont. (Koo, Naqvi); Unity Health, Toronto, Ont. (E.K.C. Wong, C.L. Wong); and the Li Ka Shing Knowledge Institute, Toronto, Ont. (E.K.C. Wong, C.L. Wong)
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Dakhil S, Thingstad P, Frihagen F, Johnsen LG, Lydersen S, Skovlund E, Wyller TB, Sletvold O, Saltvedt I, Watne LO. Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials. BMC Geriatr 2021; 21:208. [PMID: 33765935 PMCID: PMC7992808 DOI: 10.1186/s12877-021-02152-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background The incidence of hip fractures are expected to increase in the following years. Hip fracture patients have in addition to their fracture often complex medical problems, which constitute a substantial burden on society and health care systems. It is thus important to optimize the treatment of these patients to reduce negative outcomes. The aim of this study was to assess the effect of comprehensive orthogeriatric care (CGC) on basic and instrumental activities of daily living (B-ADL and I-ADL). Methods This study is based on two randomized controlled trials; the Oslo Orthogeriatric Trial and the Trondheim Hip Fracture Trial. The two studies were planned in concert, and data were pooled and analyzed using linear mixed models. I-ADL function was assessed by the Nottingham Extended ADL Scale (NEADL) and B-ADL by the Barthel ADL (BADL) at four and twelve months after surgery. Results Seven hundred twenty-six patients were included in the combined database, of which 365 patients received OC and 361 patients received CGC. For the primary endpoint, I-ADL at four months was better in the CGC group, with a between-group difference of 3.56 points (95 % CI 0.93 to 6.20, p = 0.008). The between-group difference at 12 months was 4.28 points (95 % CI 1.57 to 7.00, p = 0.002). For B-ADL, between-group difference scores were only statistically significant at 12 months. When excluding the patients living at a nursing home at admission, both I-ADL and B-ADL function was significantly better in the CGC group compared to the OC group at all time points. Conclusions Merged data of two randomized controlled trials showed that admitting hip fracture patients to an orthogeriatric care unit directly from the emergency department had a positive effect on ADL up to twelve months after surgery.
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Affiliation(s)
- Shams Dakhil
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frede Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lars Gunnar Johnsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Orthopedic Trauma Unit, Department of Orthopedic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Stian Lydersen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Sletvold
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ingvild Saltvedt
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Geriatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Leiv Otto Watne
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Wolf O, Mukka S, Ekelund J, Möller M, Hailer NP. How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11,799 femoral fractures in the Swedish Fracture Register. Acta Orthop 2021; 92:40-46. [PMID: 33103546 PMCID: PMC7919867 DOI: 10.1080/17453674.2020.1831236] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Unlike hip fractures, diaphyseal and distal femoral fractures in elderly patients have not been widely studied. We investigated the demographics, comorbidities and mortality of patients with femoral fractures at any anatomical level with a focus on early mortality.Patients and methods - We analyzed 11,799 patients ≥ 65 years with a femoral fracture registered in the Swedish Fracture Register from 2011 to 2014. The cohort was matched with the National Patient Register to obtain data on comorbidities classified according to the Charlson Comorbidity Index (CCI). Generalized linear models were fitted to estimate the adjusted relative risk of mortality.Results - Mean age of the cohort was 83 years and 69% were women. Patients with distal femoral fractures had the lowest degree of comorbidity, with 9% having a CCI of ≥ 3 compared with 14% among those with proximal and 16% among those with diaphyseal fractures. Unadjusted 90-day mortalities were 13% (95% CI 9.4-16) after fractures in the distal, 13% (CI 10-16) in the diaphyseal, and 15% (CI 14-15) in the proximal segment. The adjusted relative risk for 90-day mortality was 1.1 (CI 0.86-1.4) for patients with distal and 0.97 (CI 0.76-1.2) for patients with diaphyseal femoral fractures when compared with patients with hip fractures.Interpretation - Elderly patients with femoral fractures distal to the hip may have similar adjusted early mortality risks to those with hip fractures. There is a need for larger, preferably prospective, studies investigating the effect of rapid pathways and geriatric co-management for patients with diaphyseal and distal femoral fractures.
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Affiliation(s)
- Olof Wolf
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala; ,Correspondence:
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences at Umeå University, Umeå;
| | - Jan Ekelund
- Centre of Registers Västra Götaland, Gothenburg;
| | - Michael Möller
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nils P Hailer
- Department of Surgical Sciences, Orthopaedics, Uppsala University, Uppsala;
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Differences of hemiarthroplasty and total hip replacement in orthogeriatric treated elderly patients: a retrospective analysis of the Registry for Geriatric Trauma DGU ®. Eur J Trauma Emerg Surg 2021; 48:1841-1850. [PMID: 33392623 DOI: 10.1007/s00068-020-01559-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/16/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Medial femoral neck fractures are typically managed with hemiarthroplasty (HA) or total hip arthroplasty (THA) in elderly patients. There is a debate as to which treatment predominates. The literatures have reported better outcomes for those patients with proximal femur fracture who were treated in an orthogeriatric centres compared to standard orthopaedic hospitals. Therefore, we have analysed the differences of outcome between HA and THA on patients, exclusively treated in orthogeriatric co-management and compared the results with the available literature. METHODS We conducted a retrospective registry analysis of the Registry for Geriatric Trauma DGU®. Between 2016 and 2018, data for 16,236 patients from 78 different hospitals were available: they were analysed univariably, and differences between HA and THA were examined using propensity score matching, according to the American Society of Anesthesiologists (ASA) grade, Identification-of-Seniors-At-Risk (ISAR) Score, anticoagulation level, sex, age, and walking ability prefracture. RESULTS There were 4,662 patients treated with HA and 892 with THA, meeting inclusion criteria. Patients in the HA group were older (84 years (IQR 80-89) vs. 79 years (IQR 75-83); p < 0.001), with more severe preexisting conditions, with an ASA grade ≥ 3 in 79% vs. 57% in the THA group (p < 0.001). After matching, the mortality rate, in-house revision rate, and quality of life (QoL) 7 days postoperatively were not significantly different by group. After 120 days, the HA group presented a lower rate of surgical complications (4% vs. 10%; p = 0.006), while the THA group had a higher rate of independent walking (18% vs. 28%; p = 0.001) and a higher QoL, measured by the EQ-5D-3L (0.81 (IQR 0.7-1.0) vs. 0.9 (IQR 0.72-1.0); p = 0.01). CONCLUSIONS Due to better walking ability and QoL, THA might be the better choice in healthier and more mobile patients, while HA would be better for multimorbid patients to avoid additional complication-associated treatments. Not the age of the patient but the preoperative condition might be important for the choice between THA and HA.
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Rasidovic D, Ahmed I, Thomas C, Kimani PKU, Wall P, Mangat K. Impact of COVID-19 on clinical outcomes for patients with fractured hip: a multicentre observational cohort study. Bone Jt Open 2020; 1:697-705. [PMID: 33263109 PMCID: PMC7690757 DOI: 10.1302/2633-1462.111.bjo-2020-0132.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Aims There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Italy. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic. Methods We completed a multicentre cohort study across ten hospitals in England. Data were collected from 1 March 2020 to 6 April 2020, during which period the World Health Organization (WHO) declared COVID-19 to be a pandemic. Patients ≥ 60 years of age admitted with hip fracture and a minimum follow-up of 30 days were included for analysis. Primary outcome of interest was mortality at 30 days post-surgery or postadmission in nonoperative patients. Secondary outcomes included length of hospital stay and discharge destination. Results In total, 404 patients were included for final analysis with a COVID-19 diagnosis being made in 114 (28.2%) patients. Overall, 30-day mortality stood at 14.4% (n = 58). The COVID-19 cohort experienced a mortality rate of 32.5% (37/114) compared to 7.2% (21/290) in the non-COVID cohort (p < 0.001). In adjusted analysis, 30-day mortality was greatest in patients who were confirmed to have COVID-19 (odds ratio (OR) 5.64, 95% confidence interval (CI) 2.95 to 10.80; p < 0.001) with an adjusted excess risk of 20%, male sex (OR 2.69, 95% CI 1.37 to 5.29; p = 0.004) and in patients with ≥ two comorbidities (OR 4.68, CI 1.5 to 14.61; p = 0.008). Length of stay was also extended in the COVID-19 cohort, on average spending 17.6 days as an inpatient versus 12.04 days in the non-COVID-19 group (p < 0.001). Conclusion This study demonstrates that patients who sustain a neck of femur fracture in combination with COVID-19 diagnosis have a significantly higher risk of mortality than would be normally expected.Cite this article: Bone Joint Open 2020;1-11:697-705.
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Affiliation(s)
| | - Imran Ahmed
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | | | - Peter Wall
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
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Van Camp L, Dejaeger M, Tournoy J, Gielen E, Laurent MR. Association of orthogeriatric care models with evaluation and treatment of osteoporosis: a systematic review and meta-analysis. Osteoporos Int 2020; 31:2083-2092. [PMID: 32594206 DOI: 10.1007/s00198-020-05512-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/16/2020] [Indexed: 01/01/2023]
Abstract
UNLABELLED This systematic review and meta-analysis found low-quality evidence that orthogeriatric care is positively associated with diagnosis of osteoporosis, prescription of calcium and vitamin D supplements and bisphosphonates in older hip fracture patients. Evidence on fall and fracture prevention was scarce and inconclusive. Orthogeriatrics may reduce the treatment gap following hip fractures. INTRODUCTION Hip fracture patients are at imminent risk of additional fractures and falls. Orthogeriatric care might reduce the osteoporosis treatment gap and improve outcomes in these patients. However, the optimal orthogeriatric care model (geriatric liaison service, co-management, or geriatrician-led care) remains unclear. PURPOSE To summarize the association of different orthogeriatric care models for older hip fracture patients, compared to usual orthopaedic care, with fall prevention measures, diagnosis and treatment of osteoporosis and future falls and fractures. METHODS Two independent reviewers retrieved randomized controlled trials (RCTs) or controlled observational studies. Random effects meta-analysis was applied (PROSPERO ID: 165914). RESULTS One RCT and twelve controlled observational studies were included, encompassing 20,078 participants (68% women, median ages between 75 and 85 years). Orthogeriatric care was associated with higher odds of diagnosing osteoporosis (odds ratio [OR] 11.36; 95% confidence interval [CI] 7.26-17.77), initiation of calcium and vitamin D supplements (OR 41.44; 95% CI 7.07-242.91) and discharge on anti-osteoporosis medication (OR 7.06; 95% CI 2.87-17.34). However, there was substantial heterogeneity in these findings. Evidence on fall prevention and subsequent fractures was scarce and inconclusive. Almost all studies were at high risk of bias. Evidence was insufficient to compare different care models directly against each other. CONCLUSIONS Low-quality evidence suggests that orthogeriatric care is associated with higher rates of diagnosing osteoporosis, initiation of calcium and vitamin D supplements and anti-osteoporosis medication. Whether orthogeriatric care prevents subsequent falls and fractures in older hip fracture patients remains unclear.
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Affiliation(s)
- L Van Camp
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - M Dejaeger
- Gerontology and Geriatrics section, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - J Tournoy
- Gerontology and Geriatrics section, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - E Gielen
- Gerontology and Geriatrics section, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - M R Laurent
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Geriatrics Department, Imelda Hospital, Bonheiden, Belgium.
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Cricelli C, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Roselli M, Ruggeri M, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Management of hip fracture in the older people: rationale and design of the Italian consensus on the orthogeriatric co-management. Aging Clin Exp Res 2020; 32:1393-1399. [PMID: 32358728 DOI: 10.1007/s40520-020-01574-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hip fracture (HF) is a burdening health problem in older people. The orthogeriatric approach has been shown to favour functional recovery and reduce mortality, but its implementation in clinical practice cannot rely upon shared management protocols and greatly varies among different healthcare systems. Here, we present the rationale and design of the Italian consensus document on the management of HF in older people. METHODS A panel of multidisciplinary experts from ten Italian scientific societies involved in the care of HF and including geriatricians, orthopaedics, anaesthesiologists, physiatrists and general practitioners, will join to establish the content validity of a list of statements. A Delphi consensus methodology will be applied to obtain the opinions of the panel and to provide the final recommendations. OBJECTIVES The document will include indications on the following relevant topics: (1) optimal care path of older subjects with HF; (2) management of comorbidities and pre-operative alteration of physiological parameters; (3) management of selected categories of patients at expected increased risk of adverse outcomes; (4) continuity of care out of hospital; (5) screening and correction of risk factors for HF in older subjects; (6) information and divulgation of shared management strategies. The objective of the consensus will be to inform clinicians, patients, researchers, and health policy makers about the best management strategies for HF in older people and their inherent limitations, thus facilitating communication between stakeholders and promoting the most cost/effective models of care.
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Affiliation(s)
- Antonio De Vincentis
- Geriatric and Gerontology Department, Campus Bio-Medico University of Rome, via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Astrid Ursula Behr
- Operative Unit of Anesthesia and Resuscitation, Hospital of Camposampiero, Padua, Italy
| | - Giuseppe Bellelli
- Acute Geriatric and Orthogeriatric Unit, S. Gerardo Hospital, Monza, Italy
- Milano-Bicocca University, Milan, Italy
| | - Marco Bravi
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University of Rome, Rome, Italy
| | | | | | - Lucia Galluzzo
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Emilio Martini
- Orthogeriatric Unit, Azienda Ospedaliero Universitaria di Modena, Ospedale Civile Di Baggiovara, Modena, Italy
| | - Alberto Momoli
- Orthopedic and Traumatology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Roselli
- Orthopedic and Traumatology Unit, "Maria Vittoria" Hospital, Torino, Italy
| | - Mauro Ruggeri
- Società Italiana Di Medicina Generale (SIMG), Firenze, Italy
| | - Fabio Santacaterina
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luigi Tritapepe
- Operative Unit of Anesthesia and Intensive Care Medicine, San Camillo-Forlanini Hospital, Rome, Italy
| | - Amedeo Zurlo
- Geriatric and Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Raffaele Antonelli Incalzi
- Geriatric and Gerontology Department, Campus Bio-Medico University of Rome, via Alvaro del Portillo, 200, 00128, Rome, Italy
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