1
|
Loggers SAI, Geraerds AJLM, Joosse P, Willems HC, Gosens T, Van Balen R, Van de Ree CLP, Ponsen KJ, Steens J, Zuurmond RG, Verhofstad MHJ, Polinder S, Van Lieshout EMM. Correction to: Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study. Osteoporos Int 2023; 34:625-626. [PMID: 36648543 PMCID: PMC9908635 DOI: 10.1007/s00198-023-06673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- S A I Loggers
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A J L M Geraerds
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - P Joosse
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, P.O. Box 1074, 1940 EB, Beverwijk, the Netherlands
| | - H C Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam UMC Location AMC, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - T Gosens
- Department of Orthopedic Surgery, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, the Netherlands
| | - R Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - C L P Van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, the Netherlands
| | - K J Ponsen
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, P.O. Box 1074, 1940 EB, Beverwijk, the Netherlands
| | - J Steens
- Department of Orthopedic Surgery, Dijklander Ziekenhuis, P.O. Box 600, 1620 AR, Hoorn, the Netherlands
| | - R G Zuurmond
- Department of Orthopedic Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, the Netherlands
| | - M H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | | |
Collapse
|
2
|
Loggers SAI, Geraerds AJLM, Joosse P, Willems HC, Gosens T, Van Balen R, Van de Ree CLP, Ponsen KJ, Steens J, Zuurmond RG, Verhofstad MHJ, Polinder S, Van Lieshout EMM. Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study. Osteoporos Int 2023; 34:515-525. [PMID: 36609506 PMCID: PMC9908658 DOI: 10.1007/s00198-022-06638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023]
Abstract
UNLABELLED Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM. PURPOSE The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture. METHODS This study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective. RESULTS Of the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs. CONCLUSION OM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL. TRIAL REGISTRATION Netherlands Trial Register (NTR7245; date 10-06-2018).
Collapse
Affiliation(s)
- S A I Loggers
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - A J L M Geraerds
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - P Joosse
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, P.O. Box 1074, 1940 EB, Beverwijk, the Netherlands
| | - H C Willems
- Geriatrics Section, Department of Internal Medicine, Amsterdam UMC Location AMC, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - T Gosens
- Department of Orthopedic Surgery, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, the Netherlands
| | - R Van Balen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - C L P Van de Ree
- Department Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, the Netherlands
| | - K J Ponsen
- Department of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands
- Department of Surgery, Rode Kruis Ziekenhuis, P.O. Box 1074, 1940 EB, Beverwijk, the Netherlands
| | - J Steens
- Department of Orthopedic Surgery, Dijklander Ziekenhuis, P.O. Box 600, 1620 AR, Hoorn, the Netherlands
| | - R G Zuurmond
- Department of Orthopedic Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, the Netherlands
| | - M H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - S Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | | |
Collapse
|
3
|
Loggers SAI, Nijdam TMP, Folbert EC, Hegeman JHH, Van der Velde D, Verhofstad MHJ, Van Lieshout EMM, Joosse P. Prognosis and institutionalization of frail community-dwelling older patients following a proximal femoral fracture: a multicenter retrospective cohort study. Osteoporos Int 2022; 33:1465-1475. [PMID: 35396653 PMCID: PMC9187528 DOI: 10.1007/s00198-022-06394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
UNLABELLED Hip fractures are a serious public health issue with major consequences, especially for frail community dwellers. This study found a poor prognosis at 6 months post-trauma with regard to life expectancy and rehabilitation to pre-fracture independency levels. It should be realized that recovery to pre-trauma functioning is not a certainty for frail community-dwelling patients. INTRODUCTION Proximal femoral fractures are a serious public health issue in the older patient. Although a significant rise in frail community-dwelling elderly is expected because of progressive aging, a clear overview of the outcomes in these patients sustaining a proximal femoral fracture is lacking. This study assessed the prognosis of frail community-dwelling patients who sustained a proximal femoral fracture. METHODS A multicenter retrospective cohort study was performed on frail community-dwelling patients with a proximal femoral fracture who aged over 70 years. Patients were considered frail if they were classified as American Society of Anesthesiologists score ≥ 4 and/or a BMI < 18.5 kg/m2 and/or Functional Ambulation Category ≤ 2 pre-trauma. The primary outcome was 6-month mortality. Secondary outcomes were adverse events, health care consumption, rate of institutionalization, and functional recovery. RESULTS A total of 140 out of 2045 patients matched the inclusion criteria with a median age of 85 (P25-P75 80-89) years. The 6-month mortality was 58 out of 140 patients (41%). A total of 102 (73%) patients experienced adverse events. At 6 months post-trauma, 29 out of 120 (24%) were readmitted to the hospital. Out of the 82 surviving patients after 6 months, 41 (50%) were unable the return to their home, and only 32 (39%) were able to achieve outdoor ambulation. CONCLUSION Frail community-dwelling older patients with a proximal femoral fracture have a high risk of death, adverse events, and institutionalization and often do not reobtain their pre-trauma level of independence. Foremost, the results can be used for realistic expectation management.
Collapse
Affiliation(s)
- S A I Loggers
- Department of Surgery, Northwest Clinics Alkmaar, P.O. Box 501, 1800 AM, Alkmaar, The Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - T M P Nijdam
- Department of Surgery, St. Antonius Ziekenhuis, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - E C Folbert
- Department of Trauma Surgery, Ziekenhuisgroep Twente, P.O. Box 7600, 7600 SZ, Almelo, The Netherlands
| | - J H H Hegeman
- Department of Trauma Surgery, Ziekenhuisgroep Twente, P.O. Box 7600, 7600 SZ, Almelo, The Netherlands
| | - D Van der Velde
- Department of Surgery, St. Antonius Ziekenhuis, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - M H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - E M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - P Joosse
- Department of Surgery, Northwest Clinics Alkmaar, P.O. Box 501, 1800 AM, Alkmaar, The Netherlands
| |
Collapse
|
4
|
Loggers SAI, Koedam TWA, Giannakopoulos GF, Vandewalle E, Erwteman M, Zuidema WP. Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members. Eur J Trauma Emerg Surg 2016; 43:823-833. [PMID: 27900417 PMCID: PMC5707227 DOI: 10.1007/s00068-016-0744-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/21/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Trauma is a great contributor to mortality worldwide. One of the challenges in trauma care is early identification and management of bleeding. The circulatory status of blunt trauma patients in the emergency room is evaluated using hemodynamic (HD) parameters. However, there is no consensus on which parameters to use. In this study, we evaluate the used terms and definitions in the literature for HD stability and compare those to the opinion of Dutch trauma team members. METHOD A systematic review was performed to collect the definitions used for HD stability. Studies describing the assessment and/or treatment of blunt trauma patients in the emergency room were included. In addition, an online survey was conducted amongst Dutch trauma team members. RESULTS Out of a total of 222, 67 articles were found to be eligible for inclusion. HD stability was defined in 70% of these articles. The most used parameters were systolic blood pressure and heart rate. Besides the variety of parameters, a broad range of corresponding cut-off points is noted. Despite some common ground, high inter- and intra-variability is seen for the physicians that are part of the Dutch trauma teams. CONCLUSION All authors acknowledge HD stability as the most important factor in the assessment and management of blunt trauma patients. There is, however, no consensus in the literature as well as none-to-fair consensus amongst Dutch trauma team members in the definition of HD stability. A trauma team ready to co-operate with consensus-based opinions together with a valid scoring system is in our opinion the best method to assess and treat seriously injured trauma patients.
Collapse
Affiliation(s)
- S A I Loggers
- Department of Trauma Surgery, VU University Medical Center, 7F029, De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands.
| | - T W A Koedam
- Department of Trauma Surgery, VU University Medical Center, 7F029, De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands
| | - G F Giannakopoulos
- Department of Trauma Surgery, VU University Medical Center, 7F029, De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands
| | - E Vandewalle
- Department of Emergency Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M Erwteman
- Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands
| | - W P Zuidema
- Department of Trauma Surgery, VU University Medical Center, 7F029, De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands
| |
Collapse
|