Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture
| Autor: | Janet E. M. Bootsma, Babette C. van der Zwaard, Carolina J. P. W. Keijsers, Hendrikus J. A. A. van Geffen, Charlotte E. Stein, Conny M. Douw |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Palliative care Frail Elderly Conservative Treatment 03 medical and health sciences 0302 clinical medicine Older patients Fracture Fixation medicine Humans Orthopedics and Sports Medicine Medical history Geriatric Assessment Aged Retrospective Studies Aged 80 and over 030222 orthopedics Hip fracture business.industry Hip Fractures Trauma center Retrospective cohort study 030229 sport sciences General Medicine medicine.disease Surgery Orthopedic surgery Female business Social status |
| Zdroj: | Archives of orthopaedic and trauma surgery. 140(4) |
| ISSN: | 1434-3916 |
| Popis: | Geriatricians have been increasingly involved in the pre-operative process in frail elderly patients with a hip fracture which can benefit re-hospitalization, post-operative functional performance, and mortality. The objective of this study was to compare the number of older patients with hip fractures who opted for non-surgical management after the addition of pre-operative comprehensive geriatric assessment (CGA) with shared decision making by a geriatrician to usual care. Secondary objectives were: reasons for non-surgical management, duration of life, and location of death. A single-center, with a level 2 trauma center, retrospective study comparing care before and after introducing pre-operative CGA with shared decision making in September 2014. Patients ≥ 70 years with a hip fracture, admitted from January 2014 to September 2015, were included. The percentages of patients elected for non-surgical management and palliative care without or with CGA were compared. Differences in secondary objectives (age, sex, medical history, medication use, functional, and social status) were compared descriptively and qualitatively. With pre-operative CGA significantly more patients (or representatives) elected the non-surgical management option after hip fracture (respectively, 9.1% vs 2.7%, p = 0.008). Patient characteristics were comparable. Reported reasons not to undergo surgery include aversion to be more dependent on others, and severe dementia. The geriatrician can have an important role in decisions for non-surgical management by shared decision making in the pre-operative period in patients ≥ 70 years with a hip fracture in the emergency room. |
| Databáze: | OpenAIRE |
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