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 - Funding Information:
Contributors MB, AJ, KE-R and MG were responsible for designing the study, KE-R analysed the data and collaborated in further data interpretation, which was done by MB, AJ, ER and MG. Authors involved in acquiring data were MB, PW, RJ, MP, MKW, EBKK, JHH, CP-U, EG, TJR, SZ and DJ. ER drafted the manuscript, which was thoroughly reviewed for intellectual contents by all other authors. Funding This work was supported by the AO Foundation via the AO Trauma Network.
Publisher Copyright:
© 2021 EDP Sciences. All rights reserved.
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 - geriatric medicine
KW - health services administration & management
KW - hip
KW - orthopaedic & trauma surgery
KW - trauma management
UR - http://www.scopus.com/inward/record.url?scp=85105730298&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-039960
DO - 10.1136/bmjopen-2020-039960
M3 - Article
C2 - 33972329
AN - SCOPUS:85105730298
VL - 11
JO - BMJ open
JF - BMJ open
SN - 2044-6055
IS - 5
M1 - e039960
ER -