Abstract
Introduction
In the orthogeriatric model of care, orthopaedic surgeons, geriatricians, anesthesiologists, physiotherapists and the nursing staff work together with the aim to optimize the outcomes of vulnerable older patients undergoing orthopaedic surgery. It is recommended that the orthogeriatric care of hip fracture patients should be based on systematic treatment guidelines. We describe here how operative and perioperative management of hip fracture patients changed between the first and the second year after initiation of orthogeriatric collaboration.
Method
Data on all patients aged 65 years or over and experiencing a hip fracture between September 1st 2007 and August 31st 2009 were prospectively collected in a Finnish hospital district with a total of 200,000 inhabitants. The patients were evaluated 4–6 months postoperatively at the geriatric outpatient clinic. Starting from the second year, geriatrician's rounds 2–3 times a week at the orthopaedic ward were provided. In addition, a systematic treatment protocol agreed by orthopaedic surgeons, geriatricians and anesthesiologists was introduced to the hospital staff responsible for the care of hip fracture patients.
Results
Data were available on 177 patients in the first and 232 patients in the second year (87 % and 95 % of eligible patients, respectively). There were no significant differences in the patient characteristics in regard with age, sex distribution, prefracture mobility level, living arrangements, number of medication used, body mass index, anesthesiological risk score or the type of the fracture between the two years. Compared to the first year, the patients were more likely to be operated by a consultant orthopaedic surgeon (74 % vs. 49 %, p<0.001) and to undergo hemiarthroplasty (64 % vs. 53 %, p=0.013) during the second year. Urinary catheters were also removed before discharge from the orthopaedic ward more frequently (28 % vs. 14 %, p=0.001). There was a trend towards shorter delay to operation (<24 hours in 40 % vs. 32 %, p=0.140) and more frequent use of blood transfusions (39 % vs. 32 %, p=0.128). There was no difference in the mean length of stay at the orthopaedic ward between the two years (6 days in the first vs. 7 days in the second year, p=0.081). The 4-month mortality was 20 % in the first and 17 % in the second year (p=0.436).
Conclusions
The treatment practices showed changes towards guideline recommendations after initiation of orthogeriatric collaboration in the care of hip fracture patients without increasing the length of stay at the orthopaedic ward. Further follow-up is required to show how these improvements translate into longer-term outcomes and mortality.
