Three-year National report from the Gruppo Italiano di Ortogeriatria (GIOG) in the management of hip-fractured patients.

Autor: Ferrara MC; Geriatrics and Internal Medicine, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Andreano A; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Tassistro E; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Rapazzini P; Orthogeriatric Unit, Circolo Hospital, Varese, Italy., Zurlo A; Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy., Volpato S; Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy.; Department of Medical Sciences, University of Ferrara, Ferrara, Italy., Mussi C; Orthogeriatric Unit, University of Modena and Reggio Emilia, Modena, Italy., Corsi M; Orthogeriatric Unit, S. Gerardo Hospital, Monza, Italy., Lunardelli ML; Orthogeriatric Unit, Policlinico S. Orsola, Bologna, Italy., Martini E; Orthogeriatric Unit, Policlinico S. Orsola, Bologna, Italy., Castoldi G; Orthopedic Unit, Carate Brianza Hospital, ASST Vimercate, Vimercate, MB, Italy., De Filippi F; Orthogeriatric Unit, Hospital of Sondrio-ASST Valtellina e Alto Lario, Sondrio, Italy., Pizzonia M; Orthogeriatric Unit, S. Martino Hospital, Genoa, Italy., Monacelli F; Orthogeriatric Unit, S. Martino Hospital, Genoa, Italy., Barone A; Orthogeriatric Unit, Galliera Hospital, Genoa, Italy., Pilotto A; Orthogeriatric Unit, Galliera Hospital, Genoa, Italy., March A; Orthogeriatric Unit, Bolzano Hospital, Bolzano, Italy., Ungar A; Geriatrics and Intensive Care Unit, University of Florence and AOU Careggi, Florence, Italy., Capelli R; Orthopedic Unit, ASST Fatebenefratelli Sacco, Milan, Italy., Galmarini V; Orthopedic Unit, ASST Fatebenefratelli Sacco, Milan, Italy., Franzoni S; Orthopedic Unit, Poliambulanza Hospital, Brescia, Italy., Terragnoli F; Orthopedic Unit, Poliambulanza Hospital, Brescia, Italy., Bianchetti A; Department of Medicine and Rehabilitation, S. Anna Hospital, Brescia, Italy., Cazzulani I; Geriatrics and Internal Medicine, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Gandossi C; Geriatrics and Internal Medicine, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Valsecchi MG; Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Bellelli G; Geriatrics and Internal Medicine, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. giuseppe.bellelli@unimib.it.; Orthogeriatric Unit, S. Gerardo Hospital, Monza, Italy. giuseppe.bellelli@unimib.it.; Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy. giuseppe.bellelli@unimib.it.
Jazyk: angličtina
Zdroj: Aging clinical and experimental research [Aging Clin Exp Res] 2020 Jul; Vol. 32 (7), pp. 1245-1253. Date of Electronic Publication: 2020 Feb 05.
DOI: 10.1007/s40520-020-01488-1
Abstrakt: Background: Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers.
Methods: The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected.
Results: The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80-90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23-62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators ("pre-surgical cognitive assessment", "bone protection prescription", "use of urinary catheter" and "start of physiotherapy"), moderate in two indicators ("surgery performed ≤ 48 h from fracture" and "discharge toward rehabilitation" and low in one ("absence of delirium on day following surgery"). Comparison with international studies suggests very different ways of providing care to HF Italian patients.
Conclusions: The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.
Databáze: MEDLINE
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