Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis.
Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis.
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DOI：
10.1097/bot.0b013e3182a5a045
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发表时间：
2014-03
影响因子：
2.3
通讯作者：
Rudolph JL
中科院分区：
文献类型：
--
作者：
Grigoryan KV;Javedan H;Rudolph JL
Hip fractures are common, morbid, and costly health events that threaten the independence and function of older patients. The purpose of this systematic review and meta-analysis was to determine if ortho-geriatric collaboration models improve outcomes. Articles in English and Spanish languages were searched in electronic databases including MEDLINE, CINAHL, EMBASE, and the Cochrane Registry from 1992 to 2012. Studies were included if they described an inpatient multidisciplinary approach to hip fracture management involving an orthopedic surgeon and a geriatrician. Studies were grouped into three categories: routine geriatric consultation, geriatric ward with orthopedic consultation, and shared care. After independent review of 1,480 citations by two authors, 18 studies (9,094 patients) were identified as meeting the inclusion criteria. In-hospital mortality, length of stay, and long-term mortality outcomes were collected. A random effects model meta-analysis determined whether the ortho-geriatric collaboration was associated with improved outcomes. The overall meta-analysis found ortho-geriatric collaboration was associated with a significant reduction of in-hospital mortality (RR 0.60, 95%CI 0.43, 0.84) and long-term mortality (RR 0.83, 95%CI 0.74, 0.94). Length of stay (SMD −0.25, 95%CI −0.44, −0.05) was significantly reduced, particularly in the shared care model (SMD −0.61, 95%CI −0.95, −0.28), but heterogeneity limited this interpretation. Other variables such as time to surgery, delirium, and functional status were measured infrequently. This meta-analysis supports ortho-geriatric collaboration to improve mortality after hip repair. Further study is needed to determine the best model of ortho-geriatric collaboration, and if these partnerships improve functional outcomes.
