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<sup>®</sup> Geriatric Trauma Centre
<i>Background and Objectives</i>: 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,...
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MDPI AG
2021-11-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/11/1197 |
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| author | Markus Laubach Laura Christine Gruchow Tobias Hafner Filippo Migliorini Matthias Knobe Frank Hildebrand Miguel Pishnamaz |
| author_facet | Markus Laubach Laura Christine Gruchow Tobias Hafner Filippo Migliorini Matthias Knobe Frank Hildebrand Miguel Pishnamaz |
| author_sort | Markus Laubach |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: 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<sup>®</sup>). <i>Materials and Methods</i>: 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). <i>Results</i>: Patients in the post-GTC group (<i>n</i> = 111) were older (median age 82.0 years) compared to the pre-GTC group (<i>n</i> = 108, median age 80.0 years, <i>p</i> = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all <i>p</i> > 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, <i>p</i> = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, <i>p</i> = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, <i>p</i> = 0.094), while an ACDiT score of ≥1 was comparable between groups (<i>p</i> = 0.169). <i>Conclusions</i>: 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. |
| first_indexed | 2024-03-10T05:17:21Z |
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| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T05:17:21Z |
| publishDate | 2021-11-01 |
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| series | Medicina |
| spelling | doaj.art-009dc0f540374395b85abef2c53dc9722023-11-23T00:17:10ZengMDPI AGMedicina1010-660X1648-91442021-11-015711119710.3390/medicina57111197In-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<sup>®</sup> Geriatric Trauma CentreMarkus Laubach0Laura Christine Gruchow1Tobias Hafner2Filippo Migliorini3Matthias Knobe4Frank Hildebrand5Miguel Pishnamaz6Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, GermanyDepartment of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, GermanyDepartment of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, GermanyDepartment of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, GermanyDepartment of Orthopaedic and Trauma Surgery, Lucerne Cantonal Hospital, 6004 Lucerne, SwitzerlandDepartment of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, GermanyDepartment of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, 52074 Aachen, Germany<i>Background and Objectives</i>: 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<sup>®</sup>). <i>Materials and Methods</i>: 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). <i>Results</i>: Patients in the post-GTC group (<i>n</i> = 111) were older (median age 82.0 years) compared to the pre-GTC group (<i>n</i> = 108, median age 80.0 years, <i>p</i> = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all <i>p</i> > 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, <i>p</i> = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, <i>p</i> = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, <i>p</i> = 0.094), while an ACDiT score of ≥1 was comparable between groups (<i>p</i> = 0.169). <i>Conclusions</i>: 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.https://www.mdpi.com/1648-9144/57/11/1197fragility fractureelderlygeriatric trauma centreorthogeriatric co-management |
| spellingShingle | Markus Laubach Laura Christine Gruchow Tobias Hafner Filippo Migliorini Matthias Knobe Frank Hildebrand Miguel Pishnamaz 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<sup>®</sup> Geriatric Trauma Centre Medicina fragility fracture elderly geriatric trauma centre orthogeriatric co-management |
| title | 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<sup>®</sup> Geriatric Trauma Centre |
| title_full | 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<sup>®</sup> Geriatric Trauma Centre |
| title_fullStr | 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<sup>®</sup> Geriatric Trauma Centre |
| title_full_unstemmed | 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<sup>®</sup> Geriatric Trauma Centre |
| title_short | 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<sup>®</sup> Geriatric Trauma Centre |
| title_sort | 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 sup r sup geriatric trauma centre |
| topic | fragility fracture elderly geriatric trauma centre orthogeriatric co-management |
| url | https://www.mdpi.com/1648-9144/57/11/1197 |
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