Perioperative adverse outcomes in elderly patients with hip fracture before and after the implementation of an orthogeriatric protocol
DOI:
https://doi.org/10.58814/01208845.7Keywords:
Hip Fractures, Geriatric Assessment, Geriatrics, AgedAbstract
Introduction: Hip fracture in elderly patients is a major health concern, as it is associated with increased morbidity and mortality. For this reason, orthogeriatric protocols have been created to approach it, reporting favorable outcomes.
Objective: To evaluate adverse perioperative outcomes in elderly patients with hip fractures before and after the implementation of a comprehensive geriatric assessment (CGA) protocol.
Methodology: Case-control study performed on 136 patients (cases: 43; controls: 93) >65 years old with a hip fracture, who were treated at a referral hospital between 2020 and 2021 (cases) and 2015 and 2017 (controls). Differences between groups were determined through bivariate analysis using Fisher's chi-square or exact tests on categorical variables, and Student's t-test or Wilcoxon signed-rank test on continuous variables depending on the distribution of the data.
Results: Adverse perioperative outcomes occurred in 62.7% of cases and 84.0% of controls (p=0.007; OR:0.32; 95%CI:0.13-0.73). The median length of hospital stay was 10 and 17 days in cases and controls, respectively (IQR: 8-14; IQR 11-26), while the time between ED admission and surgery was 7 days (IQR:5-11) and 11 days (IQR:8-17), respectively (p=0.002).
Conclusions: The implementation of the CGA protocol reduced adverse outcomes associated with hip fracture, mainly the length of hospital stay and the time between admission and surgery, in which statistically significant differences were observed between both groups.
Downloads
References
Lu Y, Uppal HS. Hip Fractures: Relevant Anatomy, Classification, and Biomechanics of Fracture and Fixation. Geriatr Orthop Surg Rehabil. 2019;10: 2151459319859139. https://doi.org/jwt2.
Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49(8):1458–60. https://doi.org/gd5cz5.
Negrete-Corona J, Alvarado-Soriano J, Reyes-Santiago LA. Fractura de cadera como factor de riesgo en la mortalidad en pacientes mayores de 65 anos. Estudio de casos y controles. Acta Ortop. Mex. 2014;28(6):352–62.
Uribe Rios A, Castano Herrera DA, Garcia Ortega AN, Pardo Aluma EE. Morbilidad y mortalidad en pacientes mayores de 60 anos con fractura de cadera en el Hospital Universitario San Vicente Fundacion, de Medellin, Colombia. Iatreia. 2012;25(4):305–13.
Alarcon T, Gonzalez-Montalvo JI. Fractura de cadera en el paciente mayor. Rev Esp Geriatr Gerontol. 2010;45(3):167–70. https://doi.org/ctc3dr.
Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: A review. World J Orthop. 2014;5(4):402–11. https://doi.org/gmwd36.
Bessissow A, Chaudhry H, Bhandari M, Devereaux PJ. Accelerated versus standard care in hip fracture patients: does speed save lives? J Comp Eff Res. 2014;3(2):115–8. https://doi.org/jwt3.
Sanz-Reig J, Salvador Marin J, Perez Alba JM, Ferrandez Martinez J, Orozco Beltran D, Martinez Lopez JF. Risk factors for in-hospital mortality following hip fracture. Rev Esp Cir Ortop Traumatol. 2017;61(4):209–15.
Belmont Jr PJ, Garcia EJ, Romano D, Bader JO, Nelson K, Schoenfeld AJ. Risk factors for complications and in‑hospital mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg. 2014;134:597–604. https://doi.org/jwt4.
Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ. Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Joint J. 2013;97(18):246–51. https://doi.org/gndmtg.
Koso R, Sheets C, Richardson WJ, Galanos AN. Hip Fracture in the Elderly Patients: A Sentinel Event. Am J Hosp Palliat Care. 2018;35(4):612–9. https://doi.org/gk5gsc.
Friedman SM, Mendelson DA, Bingham KW, Kates SL. Impact of a Comanaged Geriatric Fracture Center on Short-term Hip Fracture Outcomes. Arch Intern Med. 2009;169(18):1712–7. https://doi.org/dpnt25.
World Medical Association (WMA). WMA Declaration of Helsinki – Ethical principles for medical research involving human subjects. Fortaleza: 64th WMA General Assembly; 2013.
Colombia. Ministerio de Salud. Resolucion 8430 de 1993 (octubre 4): Por la cual se establecen las normas cientificas, tecnicas y administrativas para la investigacion en salud. Bogota D.C.; octubre 4 de 1993 [cited 2023 Feb 13]. Available from: https://bit.ly/31gu7do.
Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc. 2005;53(9):1476–82. https://doi.org/bhq4pb.
Wallace R, Angus LDG, Munnangi S, Shukry S, DiGiacomo JC, Ruotolo C. Improved outcomes following implementation of a multidisciplinary care pathway for elderly hip fractures. Aging Clin Exp Res. 2019;31(2):273–8. https://doi.org/ggcsrc.
Baroni M, Serra R, Boccardi V, Ercolani S, Zengarini E, Casucci P, et al. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int. 2019;30(4):907–16. https://doi.org/ggcsrt.
Kusen JQ, Schafroth B, Poblete B, van der Vet PCR, Link BC, Wijdicks FJG, et al. The implementation of a Geriatric Fracture Centre for hip fractures to reduce mortality and morbidity: an observational study. Arch Orthop Trauma Surg. 2019;139(12):1705–12. https://doi.org/gh34vr.
Soejono CH. The impact of “comprehensive geriatric assessment (CGA)” implementation on the effectiveness and cost (CEA) of healthcare in an acute geriatric ward. Acta Med Indones. 2008;40(1):3–10.
Gonzalez-Montalvo JI, Alarcon T, Mauleon JL, Gil-Garay E, Gotor P, Martin-Vega A. The orthogeriatric unit for acute patients: A new model of care that improves efficiency in the management of patients with hip fracture. Hip Int. 2010;20(2):229–35. https://doi.org/jw95.
Viveros-Garcia JC, Rodriguez-Sanchez B, Baldenebro-Lugo LS, Guillermo-Nuncio EA, Nieto-Sandoval HR, Vazquez-Cantero E. Costos por la demora quirurgica en la fractura de cadera por fragilidad. Orthotips. 2021;17(4):195–201. https://doi.org/jw96.
Eamer G, Saravana-Bawan B, van der Westhuizen B, Chambers T, Ohinmaa A, Khadaroo RG. Economic evaluations of comprehensive geriatric assessment in surgical patients: a systematic review. J Surg Res. 2017;218:9–17. https://doi.org/gnwjhn.
Pajulammi HM, Pihlajamaki HK, Luukkaala TH, Jousmaki JJ, Jokipii PH, Nuotio MS. The Effect of an In-Hospital Comprehensive Geriatric Assessment on Short-Term Mortality During Orthogeriatric Hip Fracture Program—Which Patients Benefit the Most? Geriatr Orthop Surg Rehabil. 2017;8(4):183–91. https://doi.org/jw97.
Romero M, Cadena MO, Santamaria Y, Osma J, Marquez K, Parra N. Mortalidad intrahospitalaria en pacientes con fractura de cadera en el Hospital Universitario de Santander entre 2012 y 2017, en Bucaramanga, Colombia. Rev argent endocrinol metab. 2022;59(1):69–75.
Lee YH, Oh HK, Kim DW, Ihn MH, Kim JH, Son IT, et al. Use of a comprehensive geriatric assessment to predict short-term postoperative outcome in elderly patients with colorectal cancer. Ann Coloproctol. 2016;32(5):161–9. https://doi.org/f9jmxn.
Kim K il, Park KH, Koo KH, Han HS, Kim CH. Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery. Arch Gerontol Geriatr. 2013;56(3):507–12. https://doi.org/gjjwwj.
Lin SN, Su SF, Yeh WT. Meta-analysis: Effectiveness of Comprehensive Geriatric Care for Elderly Following Hip Fracture Surgery. West J Nurs Res. 2020;42(4):293–305. https://doi.org/jw98.
Middleton M, Wan B, da Assuncao R. Improving hip fracture outcomes with integrated orthogeriatric care: A comparison between two accepted orthogeriatric models. Age Ageing. 2017;46(3):465–70. https://doi.org/gm26dx.
Dakhil S, Thingstad P, Frihagen F, Johnsen LG, Lydersen S, Skovlund E, et al. Orthogeriatrics prevents functional decline in hip fracture patients: report from two randomized controlled trials. BMC Geriatr. 2021;21(1):1–8. https://doi.org/jw99.
Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, et al. Comprehensive geriatric care for patients with hip fractures: A prospective, randomised, controlled trial. Lancet. 2015;385(9978):1623–33. https://doi.org/f27mzb.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Revista Colombiana de ortopedia y traumatología
This work is licensed under a Creative Commons Attribution 3.0 Unported License.
Derechos de autor
Los autores aceptar transferir a la Revista Colombiana de Ortopedia y Traumatología los derechos edición, publicación y reproducción de los artículos publicados. La editorial tiene el derecho del uso, reproducción, transmisión, distribución y publicación en cualquier forma o medio. Los autores no podrán permitir o autorizar el uso de la contribución sin el consentimiento escrito de la revista. Una vez firmada por todos los autores, la carta de Cesión de derechos debe ser cargada en el paso dos del envío.
Aquellos autores que tengan publicaciones en esta revista aceptan los siguientes términos:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web), lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
