Geriatric fracture centre vs usual care after proximal femur fracture in older patients
| Autor: | Ernest Beng Kee Kwek, Elke Rometsch, Enrique Guerado, Kathrin Espinoza-Rebmann, Alexander Joeris, Carlos Perez-Uribarri, Rahat Jarayabhand, Michael Blauth, Pannida Wattanapanom, Thomas J Revak, Martijn Poeze, David Joseph, Markus Gosch, Sebastian Zohner, Johannes H Hegeman, Merng K Wong |
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| Přispěvatelé: | Surgery, MUMC+: NAZL en ROAZ (9), MUMC+: MA Heelkunde (9), RS: NUTRIM - R3 - Respiratory & Age-related Health |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
hip health services administration & management Psychological intervention CLINICAL PATHWAY DIAGNOSIS ORTHOGERIATRIC CARE Cohort Studies orthopaedic & trauma surgery 03 medical and health sciences 0302 clinical medicine Quality of life Internal medicine medicine 80 and over MANAGEMENT Humans QUALITY 030212 general & internal medicine Femur Prospective Studies Adverse effect Aged Hip Fractures/surgery Geriatrics Aged 80 and over 030222 orthopedics Proximal femur CONGESTIVE-HEART-FAILURE business.industry Hip Fractures geriatric medicine Incidence (epidemiology) MORTALITY LENGTH-OF-STAY HIP FRACTURE General Medicine Quality of Life trauma management Medicine Delirium Health Services Research medicine.symptom business INTERVENTION Cohort study |
| Zdroj: | BMJ Open BMJ Open, 11(5):039960. BMJ Publishing Group BMJ Open, Vol 11, Iss 5 (2021) |
| ISSN: | 2044-6055 |
| Popis: | ObjectiveThe 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.DesignCohort study recruiting patients between June 2015 and January 2017. Follow-up was 1 year.SettingInternational (six countries, three continents) multicentre study.Participants281 patients aged ≥70 with operatively treated proximal femur fractures.InterventionsTreatment in UCCs (n=139) or GFCs (n=142), that is, interdisciplinary treatment including regular geriatric consultation and daily physiotherapy.Outcome measuresPrimary 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.ResultsPatients 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, pConclusionsContrary 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 numberClinicalTrials.gov: NCT02297581. |
| Databáze: | OpenAIRE |
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