Orthogeriatric co-management and risk of rehospitalization in older patients with osteoporotic fractures: a retrospective cohort study from Germany.

BACKGROUND

As bone mass decreases with age, older people are at an increased risk of fractures, often accompanied by frailty and comorbidities. Specialized geriatric teams can be involved in treating these patients by providing orthogeriatric co-management (OGCM). Previous studies have investigated the effectiveness of OGCM regarding health-related outcomes in older patients with hip fractures. However, evidence regarding adverse health events, such as rehospitalization, and other types of osteoporotic fractures, is limited. This study aimed to investigate the associations between hospital-level OGCM availability and the risk of rehospitalization in patients with osteoporotic fractures.

METHODS

This retrospective cohort study was based on health insurance data from 209,885 patients aged [Formula: see text]80 years who were admitted to a German hospital with one of five types of osteoporotic fractures. We defined patient-relevant states within 180 days after initial hospitalization as discharge to home, transfer to subacute rehabilitation (TSR), institutionalization, rehospitalization, or death, and estimated the hazards of transitions between these states in a multistate model. We defined the control and intervention groups based on the availability of OGCM expertise at the hospital level, which we derived from the annual number of reimbursed procedure codes. We modeled dependencies of the hazards on the time since admission and the time since other post-discharge events.

RESULTS

We found that the association between OGCM availability and the rehospitalization hazard depended on the discharge state and was lowest among patients with TSR. The overall association, estimated across all discharge states, was statistically significant in patients with hip fractures (hazard ratio (HR) and 95% confidence interval 0.91 (0.883, 0.945)) and spinal fractures (HR 0.95 (0.919, 0.992)). There were also statistically non-significant overall reductions among patients with pelvic fractures (HR 0.96 (0.914, 1.005)) or forearm fractures (HR 0.96 (0.915, 1.009)). Among patients with humeral fractures, however, we only observed a reduction in those with TSR (HR 0.88 (0.759, 1.029)) or institutionalization (HR 0.95 (0.880, 1.030)), but not among those discharged to home without TSR.

CONCLUSIONS

Our study suggests beneficial associations between OGCM availability and the hazard of rehospitalization, and that the benefit is greatest in combination with subacute rehabilitation.