TY - JOUR
T1 - Geriatric fracture centre vs usual care after proximal femur fracture in older patients
T2 - what are the benefits? Results of a large international prospective multicentre study
AU - Blauth, Michael
AU - Joeris, Alexander
AU - Rometsch, Elke
AU - Espinoza-Rebmann, Kathrin
AU - Wattanapanom, Pannida
AU - Jarayabhand, Rahat
AU - Poeze, Martijn
AU - Wong, Merng K
AU - Kwek, Ernest B K
AU - Hegeman, Johannes H
AU - Perez-Uribarri, Carlos
AU - Guerado, Enrique
AU - Revak, Thomas J
AU - Zohner, Sebastian
AU - Joseph, David
AU - Gosch, Markus
N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/5/10
Y1 - 2021/5/10
N2 - OBJECTIVE: The aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.DESIGN: Cohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.SETTING: International (six countries, three continents) multicentre study.PARTICIPANTS: 281 patients aged ≥70 with operatively treated proximal femur fractures.INTERVENTIONS: Treatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.OUTCOME MEASURES: Primary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.RESULTS: Patients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).CONCLUSIONS: Contrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02297581.
AB - OBJECTIVE: The aim of this study was to determine the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures compared with usual care centres (UCC). Secondary objectives included hospital-workflow and mobility-related outcomes.DESIGN: Cohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.SETTING: International (six countries, three continents) multicentre study.PARTICIPANTS: 281 patients aged ≥70 with operatively treated proximal femur fractures.INTERVENTIONS: Treatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.OUTCOME MEASURES: Primary outcome was occurrence of prespecified MAEs, including delirium. Secondary outcomes included any other adverse events, time to surgery, time in acute ward, 1-year mortality, mobility, and quality of life.RESULTS: Patients treated in GFCs (n=142) had a mean age of 81.9 (SD, 6.6) years versus 83.9 (SD 6.9) years in patients (n=139) treated in UCCs (p=0.013) and a higher mean Charlson Comorbidity Index of 2.0 (SD, 2.1) versus 1.2 (SD, 1.5) in UCCs (p=0.001). More patients in GFCs (28.2%) experienced an MAE during the first year after surgery compared with UCCs (7.9%) with an OR of 4.56 (95% CI 2.23 to 9.34, p<0.001). Analysing individual MAEs, this was significant for pneumonia (GFC: 9.2%; UCC: 2.9%; OR, 3.40 (95% CI 1.08 to 10.70), p=0.027) and delirium (GFC: 11.3%; UCC: 2.2%, OR, 5.76 (95% CI 1.64 to 20.23), p=0.002).CONCLUSIONS: Contrary to our study hypothesis, the rate of MAEs was higher in GFCs than in UCCs. Delirium was revealed as a main contributor. Most likely, this was based on improved detection rather than a truly elevated incidence, which we interpret as positive effect of geriatric comanagement.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02297581.
KW - Aged
KW - Aged, 80 and over
KW - Cohort Studies
KW - Femur
KW - Hip Fractures/surgery
KW - Humans
KW - Prospective Studies
KW - Quality of Life
KW - MORTALITY
KW - DIAGNOSIS
KW - QUALITY
KW - MANAGEMENT
KW - CLINICAL PATHWAY
KW - trauma management
KW - LENGTH-OF-STAY
KW - orthopaedic & trauma surgery
KW - hip
KW - HIP FRACTURE
KW - ORTHOGERIATRIC CARE
KW - geriatric medicine
KW - health services administration & management
KW - CONGESTIVE-HEART-FAILURE
KW - INTERVENTION
U2 - 10.1136/bmjopen-2020-039960
DO - 10.1136/bmjopen-2020-039960
M3 - Article
C2 - 33972329
SN - 2044-6055
VL - 11
SP - e039960
JO - BMJ Open
JF - BMJ Open
IS - 5
M1 - 039960
ER -