Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference?
Abstract Background Proximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Most previo...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12891-020-03392-1 |
| _version_ | 1818506002001035264 |
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| author | Maic Werner Olaf Krause Christian Macke Lambert Herold Alexander Ranker Christian Krettek Emmanouil Liodakis |
| author_facet | Maic Werner Olaf Krause Christian Macke Lambert Herold Alexander Ranker Christian Krettek Emmanouil Liodakis |
| author_sort | Maic Werner |
| collection | DOAJ |
| description | Abstract Background Proximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Most previous studies have focused on relatively comprehensive care models. Models with only a few additions to the usual care have not been extensively evaluated. Methods This retrospective observational study included all patients aged ≥70 years (mean age: 84.5 ± 7.1 years, 70% women) with an isolated proximal femoral fracture treated surgically in our institution from May 2018 to October 2019. In the first 9 months, patients were treated with the usual care (control group, n = 103). In the second 9 months, patients were treated with our multidisciplinary care model (intervention group, n = 104), which included the usual care, plus: (1) one multidisciplinary ward round per week and (2) one “elective” operation slot per day reserved for proximal femoral fractures. Baseline characteristics and outcome measures of the hospital stay were extracted from electronic health records. A 3-month follow-up was conducted by phone. Results Baseline characteristics were comparable between groups (p > 0.05). The hospital stay was shorter in the intervention group than in the control group (7.8 ± 4.3 vs. 9.1 ± 4.5; p = 0.022). The intervention reduced the waiting time for surgery by more than 10 h (intervention: 25.4 ± 24.5 vs. control: 35.8 ± 34.1 h; p = 0.013). A structured phone interview was not performed in 30.9% of the cases. The model reduced the overall dissatisfaction rate by more than half (12.9% vs. 32.4%; p = 0.008). On the other hand, the groups had similar perioperative complication rates (25% vs. 24.3%; p > 0.9999) and mortality (4.8% vs. 3.9%; p > 0.9999) and they remained similar at the 3-month follow-up (complications: 20.3% vs. 17.6% p = 0.831, mortality: 18.2% vs. 15.0% p = 0.573). Conclusion We found that two additions to the usual proximal femoral fracture regimen could significantly improve the overall satisfaction rate, reduce the length of hospital stay and shorten the waiting time for surgery. In contrast to previous studies, we observed no significant improvements in complication or mortality rates. Further changes in the standard care might be needed for this purpose. |
| first_indexed | 2024-12-10T21:58:31Z |
| format | Article |
| id | doaj.art-855f0c106b584689ba63368710ab43ca |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-10T21:58:31Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-855f0c106b584689ba63368710ab43ca2022-12-22T01:31:58ZengBMCBMC Musculoskeletal Disorders1471-24742020-06-0121111010.1186/s12891-020-03392-1Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference?Maic Werner0Olaf Krause1Christian Macke2Lambert Herold3Alexander Ranker4Christian Krettek5Emmanouil Liodakis6Trauma Department, Hannover Medical School (MHH)Institute for General Medicine, Hannover Medical School (MHH)Trauma Department, Hannover Medical School (MHH)Trauma Department, Hannover Medical School (MHH)Trauma Department, Hannover Medical School (MHH)Trauma Department, Hannover Medical School (MHH)Trauma Department, Hannover Medical School (MHH)Abstract Background Proximal femoral fractures are a major socioeconomic burden and they occur mainly in geriatric patients. High mortality and complication rates are reported. To reduce the mortality and morbidity of these patients, co-management with geriatricians has been recommended. Most previous studies have focused on relatively comprehensive care models. Models with only a few additions to the usual care have not been extensively evaluated. Methods This retrospective observational study included all patients aged ≥70 years (mean age: 84.5 ± 7.1 years, 70% women) with an isolated proximal femoral fracture treated surgically in our institution from May 2018 to October 2019. In the first 9 months, patients were treated with the usual care (control group, n = 103). In the second 9 months, patients were treated with our multidisciplinary care model (intervention group, n = 104), which included the usual care, plus: (1) one multidisciplinary ward round per week and (2) one “elective” operation slot per day reserved for proximal femoral fractures. Baseline characteristics and outcome measures of the hospital stay were extracted from electronic health records. A 3-month follow-up was conducted by phone. Results Baseline characteristics were comparable between groups (p > 0.05). The hospital stay was shorter in the intervention group than in the control group (7.8 ± 4.3 vs. 9.1 ± 4.5; p = 0.022). The intervention reduced the waiting time for surgery by more than 10 h (intervention: 25.4 ± 24.5 vs. control: 35.8 ± 34.1 h; p = 0.013). A structured phone interview was not performed in 30.9% of the cases. The model reduced the overall dissatisfaction rate by more than half (12.9% vs. 32.4%; p = 0.008). On the other hand, the groups had similar perioperative complication rates (25% vs. 24.3%; p > 0.9999) and mortality (4.8% vs. 3.9%; p > 0.9999) and they remained similar at the 3-month follow-up (complications: 20.3% vs. 17.6% p = 0.831, mortality: 18.2% vs. 15.0% p = 0.573). Conclusion We found that two additions to the usual proximal femoral fracture regimen could significantly improve the overall satisfaction rate, reduce the length of hospital stay and shorten the waiting time for surgery. In contrast to previous studies, we observed no significant improvements in complication or mortality rates. Further changes in the standard care might be needed for this purpose.http://link.springer.com/article/10.1186/s12891-020-03392-1Proximal femoral fractureOrthogeriatric co-managementCo-managementGeriatricSatisfactionLength of stay |
| spellingShingle | Maic Werner Olaf Krause Christian Macke Lambert Herold Alexander Ranker Christian Krettek Emmanouil Liodakis Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference? BMC Musculoskeletal Disorders Proximal femoral fracture Orthogeriatric co-management Co-management Geriatric Satisfaction Length of stay |
| title | Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference? |
| title_full | Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference? |
| title_fullStr | Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference? |
| title_full_unstemmed | Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference? |
| title_short | Orthogeriatric co-management for proximal femoral fractures. Can two additions make a big difference? |
| title_sort | orthogeriatric co management for proximal femoral fractures can two additions make a big difference |
| topic | Proximal femoral fracture Orthogeriatric co-management Co-management Geriatric Satisfaction Length of stay |
| url | http://link.springer.com/article/10.1186/s12891-020-03392-1 |
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