The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study
(1) <b>Background:</b> Hip fracture patients with very limited life expectancy can opt for non-operative management (NOM) within a palliative care context. The implementation of NOM in the palliative context may affect the mortality of the operatively treated population. This retrospecti...
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| Format: | Article |
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MDPI AG
2024-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/7/2012 |
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| author | Thomas Nijdam Tim Schiepers Duco Laane Henk Jan Schuijt Detlef van der Velde Diederik Smeeing |
| author_facet | Thomas Nijdam Tim Schiepers Duco Laane Henk Jan Schuijt Detlef van der Velde Diederik Smeeing |
| author_sort | Thomas Nijdam |
| collection | DOAJ |
| description | (1) <b>Background:</b> Hip fracture patients with very limited life expectancy can opt for non-operative management (NOM) within a palliative care context. The implementation of NOM in the palliative context may affect the mortality of the operatively treated population. This retrospective cohort study aimed to determine whether the operatively treated geriatric hip fracture population would have a lower in-hospital mortality rate and fewer postoperative complications after the introduction of NOM within a palliative care context for patients with very limited life expectancy. (2) <b>Methods:</b> Data from 1 February 2019 to 1 February 2022 of patients aged 70 years or older were analyzed to give a comparison between patients before and after implementation of NOM within a palliative care context. (3) <b>Results:</b> Comparison between 550 patients before and 485 patients after implementation showed no significant difference in in-hospital or 1-year mortality rates (2.9% vs. 1.4%, <i>p</i> = 0.139; 22.4% vs. 20.2%, <i>p</i> = 0.404, respectively). Notably, post-implementation, fewer patients had prior dementia diagnoses (15% vs. 21%, <i>p</i> = 0.010), and intensive care unit admissions decreased (3.5% vs. 1.2%, <i>p</i> = 0.025). (4) <b>Conclusions:</b> The implementation of NOM within a palliative care context did not significantly reduce mortality or complications. However, NOM within palliative care is deemed a more patient-centered approach for geriatric hip fracture patients with very limited life expectancy. |
| first_indexed | 2024-04-24T10:41:34Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-24T10:41:34Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-c37117daeb8c47f594393b3d6f498c322024-04-12T13:21:17ZengMDPI AGJournal of Clinical Medicine2077-03832024-03-01137201210.3390/jcm13072012The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort StudyThomas Nijdam0Tim Schiepers1Duco Laane2Henk Jan Schuijt3Detlef van der Velde4Diederik Smeeing5Department of Trauma Surgery, St. Antonius Hospital Utrecht, 3543 AZ Utrecht, The NetherlandsDepartment of Trauma Surgery, St. Antonius Hospital Utrecht, 3543 AZ Utrecht, The NetherlandsDepartment of Trauma Surgery, St. Antonius Hospital Utrecht, 3543 AZ Utrecht, The NetherlandsDepartment of Trauma Surgery, St. Antonius Hospital Utrecht, 3543 AZ Utrecht, The NetherlandsDepartment of Trauma Surgery, St. Antonius Hospital Utrecht, 3543 AZ Utrecht, The NetherlandsDepartment of Trauma Surgery, St. Antonius Hospital Utrecht, 3543 AZ Utrecht, The Netherlands(1) <b>Background:</b> Hip fracture patients with very limited life expectancy can opt for non-operative management (NOM) within a palliative care context. The implementation of NOM in the palliative context may affect the mortality of the operatively treated population. This retrospective cohort study aimed to determine whether the operatively treated geriatric hip fracture population would have a lower in-hospital mortality rate and fewer postoperative complications after the introduction of NOM within a palliative care context for patients with very limited life expectancy. (2) <b>Methods:</b> Data from 1 February 2019 to 1 February 2022 of patients aged 70 years or older were analyzed to give a comparison between patients before and after implementation of NOM within a palliative care context. (3) <b>Results:</b> Comparison between 550 patients before and 485 patients after implementation showed no significant difference in in-hospital or 1-year mortality rates (2.9% vs. 1.4%, <i>p</i> = 0.139; 22.4% vs. 20.2%, <i>p</i> = 0.404, respectively). Notably, post-implementation, fewer patients had prior dementia diagnoses (15% vs. 21%, <i>p</i> = 0.010), and intensive care unit admissions decreased (3.5% vs. 1.2%, <i>p</i> = 0.025). (4) <b>Conclusions:</b> The implementation of NOM within a palliative care context did not significantly reduce mortality or complications. However, NOM within palliative care is deemed a more patient-centered approach for geriatric hip fracture patients with very limited life expectancy.https://www.mdpi.com/2077-0383/13/7/2012hip fracturegeriatricmortalitycomplicationspalliativenon-operative |
| spellingShingle | Thomas Nijdam Tim Schiepers Duco Laane Henk Jan Schuijt Detlef van der Velde Diederik Smeeing The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study Journal of Clinical Medicine hip fracture geriatric mortality complications palliative non-operative |
| title | The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study |
| title_full | The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study |
| title_fullStr | The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study |
| title_full_unstemmed | The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study |
| title_short | The Impact of Implementation of Palliative, Non-Operative Management on Mortality of Operatively Treated Geriatric Hip Fracture Patients: A Retrospective Cohort Study |
| title_sort | impact of implementation of palliative non operative management on mortality of operatively treated geriatric hip fracture patients a retrospective cohort study |
| topic | hip fracture geriatric mortality complications palliative non-operative |
| url | https://www.mdpi.com/2077-0383/13/7/2012 |
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