The implementation of a Geriatric Fracture Centre for hip fractures to reduce mortality and morbidity: an observational study
- 92 Downloads
The aim of this study was to evaluate the effect of an orthogeriatric treatment model on elderly patients with traumatic hip fractures (THF). The Geriatric Fracture Centre (GFC) is a multidisciplinary care pathway with attention for possible age-related diseases, discharge management and out-of-hospital treatment.
Materials and methods
A prospective cohort study with a historical cohort group was conducted at a level I trauma centre in Switzerland. Patients over the age of 70 years with THFs who underwent surgical treatment at GFC in 2013 and 2016 were included. Primary outcomes were mortality and complications. Secondary outcomes were hospital length of stay (HLOS), time to surgery and place of discharge.
A total of 322 patients were included in this study. In 2016, mortality showed a reduction of 2.9% at 30 days (p = 0.42) and 3.4% at 90 days (p = 0.42) and 0.1% at 1 year (p = 0.98). The number of patients with a complicated course showed a decrease of 2.2% in 2016 (p = 0.69). A significant increase in the diagnosis of delirium by 11.2% was seen in 2016 (p < 0.001). The median HLOS was significantly reduced by 2 days (p < 0.001). An increase of 21.1% was seen in patients who were sent to rehabilitation in 2016 (p < 0.001). Day-time surgery increased by 10.2% (p = 0.04).
The implementation of the GFC leads to improved processes and outcomes for geriatric patients with THFs. Increased awareness and recognition led to an increase in the diagnosis of complications that would otherwise remain untreated. Expanding these efforts might lead to more significant effects and an increase in the reduction of morbidity and mortality in the future.
KeywordsClinical pathway Hip fracture Geriatrician Elderly
Compliance with ethical standards
Conflict of interest
J. Q. Kusen, B. Schafroth, B. Poblete, P. C. R. van der Vet, B.C. Link, F. J. G. Wijdicks, R. H. Babst and F. J. P. Beeres declare that they have no conflict of interest.
- 1.Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM, Melton LJ, Cummings SR, Kanis JA, Epidemiology ICWGoF (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–1288. https://doi.org/10.1007/s00198-011-1601-6 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Saltzherr TP, Borghans HJ, Bakker RH, Go PM (2006) Proximal femur fractures in the elderly in the Netherlands during the period 1991–2004: incidence, mortality, length of hospital stay and an estimate of the care capacity needed in the future. Ned Tijdschr Geneeskd 150(47):2599–2604PubMedGoogle Scholar
- 4.Haentjens P, Magaziner J, Colon-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152(6):380–390. https://doi.org/10.7326/0003-4819-152-6-201003160-00008 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Eurostat (2016) HEDIC—Health expenditures by diseases and conditions. Eurostat. https://ec.europa.eu/eurostat/documents/3888793/7605571/KS-TC-16-008-EN-N.pdf/6cb33aa4-2e65-4df7-9b2b-1ff171eb1fba. Accessed 25 Aug 2018
- 8.Pretto M, Spirig R, Kaelin R, Muri-John V, Kressig RW, Suhm N (2010) Outcomes of elderly hip fracture patients in the Swiss healthcare system: a survey prior to the implementation of DRGs and prior to the implementation of a Geriatric Fracture Centre. Swiss Med Wkly 140:w13086. https://doi.org/10.4414/smw.2010.13086 CrossRefPubMedGoogle Scholar
- 10.Friedman SM, Mendelson DA, Kates SL, McCann RM (2008) Geriatric co-management of proximal femur fractures: total quality management and protocol-driven care result in better outcomes for a frail patient population. J Am Geriatr Soc 56(7):1349–1356. https://doi.org/10.1111/j.1532-5415.2008.01770.x CrossRefPubMedGoogle Scholar
- 11.Deutsche Gesellschaft für Unfallchirurgie. https://www.alterstraumazentrum-dgu.de/de/zertifizierung/alterstraumazentrum/zertifizierte_zentren.html. Accessed 10 Jan 2019
- 12.von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2008) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008 CrossRefGoogle Scholar
- 13.Deutsche Gesellschaft fur Unfallchirurgie D (2014) Kriterienkatalog AltersTraumaZentrum DGU®. https://www.alterstraumazentrum-dgu.de/fileadmin/user_upload/alterstraumazentrum-dgu.de/docs/AltersTraumaZentrum_DGU_Kriterienkatalog_V1.1_01.03.2014.pdf. Accessed 10 Jan 2019
- 14.Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ (1998) POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity. Br J Surg 85(9):1217–1220. https://doi.org/10.1046/j.1365-2168.1998.00840.x CrossRefPubMedGoogle Scholar
- 19.American Society of Anaesthesiologists (ASA). https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system. Accessed 13 Oct 2018
- 20.Arbeitsgemeinschaft für Osteosynthesefragen. https://www2.aofoundation.org/wps/portal/surgery?showPage=diagnosis&bone=Femur&segment=Proximal. Accessed 13 Oct 2018
- 21.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Rev Esp Cardiol (Engl Ed) 69(12):1167. https://doi.org/10.1016/j.rec.2016.11.005 CrossRefGoogle Scholar
- 22.Centers for disease control and prevention (CDC). https://www.cdc.gov/. Accessed 13 Oct 2018
- 24.Kalmet PH, Koc BB, Hemmes B, Ten Broeke RH, Dekkers G, Hustinx P, Schotanus MG, Tilman P, Janzing HM, Verkeyn JM, Brink PR, Poeze M (2016) Effectiveness of a multidisciplinary clinical pathway for elderly patients with hip fracture: a multicenter comparative cohort study. Geriatr Orthop Surg Rehabil 7(2):81–85. https://doi.org/10.1177/2151458516645633 CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Suhm N, Kaelin R, Studer P, Wang Q, Kressig RW, Rikli D, Jakob M, Pretto M (2014) Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation. Arch Orthop Trauma Surg 134(9):1261–1269. https://doi.org/10.1007/s00402-014-2057-x CrossRefPubMedGoogle Scholar
- 29.Baroni M, Serra R, Boccardi V, Ercolani S, Zengarini E, Casucci P, Valecchi R, Rinonapoli G, Caraffa A, Mecocci P, Ruggiero C (2019) The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int. https://doi.org/10.1007/s00198-019-04858-2 CrossRefPubMedGoogle Scholar
- 33.Folbert EC, Smit RS, van der Velde D, Regtuijt EM, Klaren MH, Hegeman JH (2012) Geriatric fracture center: a multidisciplinary treatment approach for older patients with a hip fracture improved quality of clinical care and short-term treatment outcomes. Geriatr Orthop Surg Rehabil 3(2):59–67. https://doi.org/10.1177/2151458512444288 CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, Germagnoli L, Liberati A, Banfi G (2012) Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS ONE 7(10):e46175. https://doi.org/10.1371/journal.pone.0046175 CrossRefPubMedPubMedCentralGoogle Scholar