Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery?
<b>Background:</b> For hip fracture patients with a limited life expectancy, operative and palliative non-operative management (P-NOM) can yield similar quality of life outcomes. However, evidence on when to abstain from surgery is lacking. The aim of this study was to quantify the influ...
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| Format: | Article |
| Language: | English |
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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/2077-0383/13/6/1594 |
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| author | Michael Bui Catharina G. M. Groothuis-Oudshoorn Annemieke Witteveen Johannes H. Hegeman |
| author_facet | Michael Bui Catharina G. M. Groothuis-Oudshoorn Annemieke Witteveen Johannes H. Hegeman |
| author_sort | Michael Bui |
| collection | DOAJ |
| description | <b>Background:</b> For hip fracture patients with a limited life expectancy, operative and palliative non-operative management (P-NOM) can yield similar quality of life outcomes. However, evidence on when to abstain from surgery is lacking. The aim of this study was to quantify the influence of patient characteristics on surgeons’ decisions to recommend P-NOM. <b>Methods:</b> Dutch surgical residents and orthopaedic trauma surgeons were enrolled in a conjoint analysis and structured expert judgement (SEJ). The participants assessed 16 patient cases comprising 10 clinically relevant characteristics. For each case, they recommended either surgery or P-NOM and estimated the 30-day postoperative mortality risk. Treatment recommendations were analysed using Bayesian logistic regression, and perceived risks were pooled with equal and performance-based weights using Cooke’s Classical Model. <b>Results:</b> The conjoint analysis and SEJ were completed by 14 and 9 participants, respectively. Participants were more likely to recommend P-NOM to patients with metastatic carcinomas (OR: 4.42, CrI: 2.14–8.95), severe heart failure (OR: 4.05, CrI: 1.89–8.29), end-stage renal failure (OR: 3.54, CrI: 1.76–7.35) and dementia (OR: 3.35, CrI: 1.70–7.06). The patient receiving the most P-NOM recommendations (12/14) had a pooled perceived risk of 30-day mortality between 50.8 and 62.7%. <b>Conclusions:</b> Overall, comorbidities had the strongest influence on participants’ decisions to recommend P-NOM. Nevertheless, practice variation and heterogeneity in risk perceptions were substantial. Hence, more decision support for considering P-NOM is needed. |
| first_indexed | 2024-04-24T18:09:36Z |
| format | Article |
| id | doaj.art-d01317e9c609470eba508c29b4399aa4 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-24T18:09:36Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d01317e9c609470eba508c29b4399aa42024-03-27T13:47:47ZengMDPI AGJournal of Clinical Medicine2077-03832024-03-01136159410.3390/jcm13061594Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery?Michael Bui0Catharina G. M. Groothuis-Oudshoorn1Annemieke Witteveen2Johannes H. Hegeman3Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7500 AE Enschede, The NetherlandsDepartment of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7500 AE Enschede, The NetherlandsDepartment of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, 7500 AE Enschede, The NetherlandsDepartment of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, 7500 AE Enschede, The Netherlands<b>Background:</b> For hip fracture patients with a limited life expectancy, operative and palliative non-operative management (P-NOM) can yield similar quality of life outcomes. However, evidence on when to abstain from surgery is lacking. The aim of this study was to quantify the influence of patient characteristics on surgeons’ decisions to recommend P-NOM. <b>Methods:</b> Dutch surgical residents and orthopaedic trauma surgeons were enrolled in a conjoint analysis and structured expert judgement (SEJ). The participants assessed 16 patient cases comprising 10 clinically relevant characteristics. For each case, they recommended either surgery or P-NOM and estimated the 30-day postoperative mortality risk. Treatment recommendations were analysed using Bayesian logistic regression, and perceived risks were pooled with equal and performance-based weights using Cooke’s Classical Model. <b>Results:</b> The conjoint analysis and SEJ were completed by 14 and 9 participants, respectively. Participants were more likely to recommend P-NOM to patients with metastatic carcinomas (OR: 4.42, CrI: 2.14–8.95), severe heart failure (OR: 4.05, CrI: 1.89–8.29), end-stage renal failure (OR: 3.54, CrI: 1.76–7.35) and dementia (OR: 3.35, CrI: 1.70–7.06). The patient receiving the most P-NOM recommendations (12/14) had a pooled perceived risk of 30-day mortality between 50.8 and 62.7%. <b>Conclusions:</b> Overall, comorbidities had the strongest influence on participants’ decisions to recommend P-NOM. Nevertheless, practice variation and heterogeneity in risk perceptions were substantial. Hence, more decision support for considering P-NOM is needed.https://www.mdpi.com/2077-0383/13/6/1594hip fracturesgeriatricsfrailtypalliative non-operative managementdecision-makingconjoint analysis |
| spellingShingle | Michael Bui Catharina G. M. Groothuis-Oudshoorn Annemieke Witteveen Johannes H. Hegeman Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery? Journal of Clinical Medicine hip fractures geriatrics frailty palliative non-operative management decision-making conjoint analysis |
| title | Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery? |
| title_full | Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery? |
| title_fullStr | Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery? |
| title_full_unstemmed | Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery? |
| title_short | Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery? |
| title_sort | palliative non operative management in geriatric hip fracture patients when would surgeons abstain from surgery |
| topic | hip fractures geriatrics frailty palliative non-operative management decision-making conjoint analysis |
| url | https://www.mdpi.com/2077-0383/13/6/1594 |
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