Gregersen, Merete6; Damsgaard, Else Marie Skjøde6; Hougaard, Kjeld7
1 Geriatrisk Afdeling, Forskningsenheden, Århus Sygehus, Faculty of Health Sciences, Aarhus University, Aarhus University2 Geatrisk afdeling G, Faculty of Health Sciences, Aarhus University, Aarhus University3 The Department of Orthopaedics E, ?AS, Faculty of Health Sciences, Aarhus University, Aarhus University4 Department of Clinical Medicine - Geriatrisk afdeling G, Department of Clinical Medicine, Health, Aarhus University5 Department of Clinical Medicine - The Department of Orthopaedics E, ?AS, Department of Clinical Medicine, Health, Aarhus University6 Department of Clinical Medicine - Geriatrisk afdeling G, Department of Clinical Medicine, Health, Aarhus University7 Department of Clinical Medicine - The Department of Orthopaedics E, ?AS, Department of Clinical Medicine, Health, Aarhus University
Introduction: Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic col-laboration (orthogeriatrics) has been organized in different ways. The aim of this study is to eva-luate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome. Methods: A total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. Data were based on medical records. The intervention group (n=233) was com-pared to a historical cohort group (n=262) receiving traditional orthopedic treatment. Intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. The intervention was provided by a multidisciplinary geriatric team. After discharge, follow-up home-visits by a physiotherapist were performed, except for patients discharged to nursing homes, due to a 24-hour staff and easy access to the GP. Results: Median length of stay was reduced from 15 to 13 days. More patients began treatment with calcium/vitamin-D and bisphosphonate (p=sig). There was no difference in hemoglobin varia-tion between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (OR) = 1.09 [95%CI: 0.71;1.67]). Discharge destination was unchanged (OR=0.93 [95%CI: 0.52; 1.65]). In-hospital mortality was 8% in the intervention group vs. 6% (p=0.48), in the control group. Three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. In the intervention group, residents from nursing homes had a higher three-month mortality (OR=2.37 [95% CI: 0.99; 5.67]), and for the intervention group, the risk of new fractures within two years decreased from 9.5% to 7.7%, though not statistically significant Conclusion: Our study indicates that co-management of hip fracture patients by orthopedic surge-ons and geriatricians may be associated with a reduction in length of hospital stay without negative-ly affecting major patient outcomes. The concept should be further developed particularly among the frail elderly.
Journal of Injury and Violence Research, 2012, Vol 4(2), Issue 45-51