Geriatric intervention in elderly patients with hip fracture in an orthopedic ward.
Geriatric intervention in elderly patients with hip fracture in an orthopedic ward.
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DOI：
10.5249/jivr.v4i2.96
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发表时间：
2012-07-01
影响因子：
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通讯作者：
Damsgaard, Else Marie
中科院分区：
文献类型：
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作者：
Gregersen, Merete;Morch, Marianne Metz;Damsgaard, Else Marie
背景：髋部骨折是老年人长期住院的常见原因。大约三分之一的患者在第一年内死亡。因此，老年病和骨科合作（orthogeriatrics）以不同的方式组织。本研究的目的是评估多学科老年院内干预对患者预后的影响。方法：对连续行骨科手术的老年髋部骨折患者495例进行随访。数据基于医疗记录。将干预组（n=233）与接受传统骨科治疗的历史队列组（n=262）进行比较。干预方案基于最初的身体和精神筛查和评估，以老年医学为重点的护理和早期出院计划。干预是由一个多学科的老年医学小组提供的。出院后，由物理治疗师进行随访家访，除了出院到疗养院的患者，因为有24小时工作人员，很容易到达全科医生。结果：中位住院时间从15天减少到13天。更多的患者开始用钙/维生素d和双膦酸盐治疗（p=sig）。入院时与入院后3 ~ 6个月血红蛋白变化无差异，3个月再入院无差异（优势比(OR) = 1.09 [95%CI: 0.71;1.67]）。出院目的地不变（OR=0.93 [95%CI: 0.52; 1.65]）。干预组住院死亡率为8%，对照组为6% （p=0.48）。干预组三个月死亡率为16%，对照组为15% （p=0.39）。在干预组中，来自养老院的居民有更高的三个月死亡率（OR=2.37 [95% CI: 0.99; 5.67]），两年内新骨折的风险从9.5%下降到7.7%，但没有统计学意义。结论：我们的研究表明，骨科医生和老年医生共同管理髋部骨折患者可能与住院时间的减少有关，而不会对患者的主要预后产生负面影响。应进一步发展这一概念，特别是在体弱多病的老年人中。
BACKGROUND: Hip fracture is a common cause of long hospital stay in the elderly. Approximately one third of these patients die within the first year. As a consequence geriatric and orthopedic collaboration (orthogeriatrics) has been organized in different ways. The aim of this study is to evaluate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome.METHODS: A total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. Data were based on medical records. The intervention group (n=233) was compared to a historical cohort group (n=262) receiving traditional orthopedic treatment. Intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. The intervention was provided by a multidisciplinary geriatric team. After discharge, follow-up home-visits by a physiotherapist were performed, except for patients discharged to nursing homes, due to a 24-hour staff and easy access to the GP.RESULTS: Median length of stay was reduced from 15 to 13 days. More patients began treatment with calcium/vitamin-D and bisphosphonate (p=sig). There was no difference in hemoglobin variation between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (OR) = 1.09 [95%CI: 0.71;1.67]). Discharge destination was unchanged (OR=0.93 [95%CI: 0.52; 1.65]). In-hospital mortality was 8% in the intervention group vs. 6% (p=0.48), in the control group. Three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. In the intervention group, residents from nursing homes had a higher three-month mortality (OR=2.37 [95% CI: 0.99; 5.67]), and the risk of new fractures within two years decreased from 9.5% to 7.7%, though not statistically significant.CONCLUSIONS: Our study indicates that co-management of hip fracture patients by orthopedic surgeons and geriatricians may be associated with a reduction in length of hospital stay without negatively affecting major patient outcomes. The concept should be further developed particularly among the frail elderly.