Readmission and mortality before and after introduction of orthogeriatric home visits: A retrospective cohort study in hip fracture patients.

Autor: Ekmann A; Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 44, 2400 Copenhagen NV, Denmark. Electronic address: anette.addy.ekmann@regionh.dk., Jensen TG; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, 2400 Copenhagen NV, Denmark. Electronic address: thomas.giver.jensen@regionh.dk., Kristensen MT; Department of Physical and Occupational Therapy, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 10, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Electronic address: morten.tange.kristensen@regionh.dk., Lunn TH; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 44, 2400 Copenhagen NV, Denmark. Electronic address: troels.haxholdt.lunn@regionh.dk., Pressel E; Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 44, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Electronic address: eckart.pressel@regionh.dk., Palm H; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Electronic address: henrik.palm@regionh.dk., Suetta C; Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 44, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Electronic address: charlotte.suetta@regionh.dk., Overgaard S; Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Electronic address: soeren.overgaard@regionh.dk., Aasbrenn M; Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 44, 2400 Copenhagen NV, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark. Electronic address: aasbrenn@sund.ku.dk.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 Dec; Vol. 55 (12), pp. 111937. Date of Electronic Publication: 2024 Oct 03.
DOI: 10.1016/j.injury.2024.111937
Abstrakt: Introduction: Orthogeriatric collaboration in hip fracture patients during admission is well established, however, orthogeriatric involvement after discharge is not common. The aim of this study was to explore the association of orthogeriatric home visits with 30-day and 120-day readmission and mortality in ≥ 65-year-old patients surgically treated for hip fractures.
Materials and Methods: A cohort of patients who underwent acute hip fracture surgery in an usual care period from January 2018 to December 2018 was compared with a cohort of patients in an intervention period from June 2020 to June 2021. During the intervention period, patients were offered orthogeriatric home visits at day 2 and 9 after discharge. The home visits were performed by orthogeriatric nurses, in close collaboration with geriatricians and orthopedic surgeons based in the local hospital. Readmission was defined as ≥ 12 h hospital stay, regardless of reason. For the main analysis, we applied Cox-regression models adjusted for age, sex, New Mobility Score, Cumulated Ambulation Score regained, cognitive function, Charlson Comorbidity Index, complications, medication, discharge destination and emergency department visits.
Results: In total, 292 patients were included during the usual care period, and 308 patients during the intervention period. Thirty- and 120-day readmission rates were 27.7 % and 41.4 % in the usual care cohort vs. 21.8 % and 35.1 % in the home visit cohort. Adjusted Hazard Ratios for readmission in the intervention cohort after 30 and 120 days were 0.67 (CI95 %: 0.48-0.93) and 0.71 (CI95 %: 0.54-0.93) respectively. Thirty- and 120-day mortality rates were 7.2 % and 20.9 % in the usual care cohort versus 5.8 % and 13.3 % in the intervention cohort. Adjusted Hazard Ratios for mortality in the intervention cohort after 30 and 120 days were 0.68 (CI95 %: 0.35-1.31) and 0.56 (CI95 %: 0.37-0.84) respectively.
Conclusions: In a period where hip fracture patients were offered two home visits after discharge, we observed lower 30- and 120- day readmission, and lower 120-day mortality, calling for more studies with a randomized design.
Competing Interests: Declaration of competing interest The authors have no competing interests to declare.
(Copyright © 2024. Published by Elsevier Ltd.)
Databáze: MEDLINE
Externí odkaz: