Journal of orthopaedic surgery and research · 2025
Difference in discharge disposition, adherence to clinical care standards and functional outcomes of older hip fracture patients receiving an orthogeriatric model of care versus routine care.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Netzer Seraina, Ruch Christian, Ivanova Silviya, Limacher Andreas, Meyer Lisa, Eggimann Anna K
Аннотация
BACKGROUND: Hip fractures are a common injury among older adults, leading to higher morbidity and mortality. Effective treatment pathways are needed. We aimed to compare an orthogeriatric model of care (OMC) and routine care in older hip fracture patients regarding discharge disposition, adherence to clinical care standards and functional outcomes.
METHODS: We performed a retrospective cohort study in patients aged ≥ 70 years with acute hip fracture consecutively admitted to a tertiary Swiss hospital between January 1, 2023 and December 31, 2023 (n = 100). Patients meeting eligibility criteria (≥ 3 geriatric syndromes, no severe dementia) received OMC (n = 46) including an intensive multiprofessional rehabilitation program (MRP) comprising 7 physical, 2 nutritional, and 1 occupational therapy sessions led by a geriatrician during the acute hospital stay. All other patients received routine care (n = 56) on the same acute ward led by an orthopedic surgeon. Discharge destination, adherence to nine pre-specified clinical care standards and functional outcomes (Barthel index [BI] and De Morton Mobility index [DEMMI]), were assessed.
RESULTS: Mean age was 83.6 years, 59% were female, and 66% frail (Clinical Frailty Scale ≥ 5). Overall, 30 patients (65.2%) in the OMC were discharged to inpatient geriatric rehabilitation compared to 15 patients (27.8%) in routine care. After post-acute rehabilitation, 23 patients (50%) in the OMC versus 16 patients (29.6%) in routine care were discharged home. Length of stay was similar in the OMC versus routine care (10.8 vs. 9.4 days). Mean adherence to nine clinical care standards was 87.9% in the OMC versus 58.7% in routine care. In OMC patients, adherence was lowest for pain management using a femoral nerve block (58.7%), and full-weight bearing (76.1%), while full adherence was observed for mobilization the first day after surgery. In the OMC, functional outcomes improved within 7 days (median increase BI 10 points, DEMMI 8 points).
CONCLUSIONS: The OMC including MRP resulted in higher numbers discharged to post-acute rehabilitation and to home afterwards, as well as improvement of adherence to clinical care standards and functional outcomes, suggesting that OMC is a promising care model. Refinement of OMC is needed to optimize adherence to full weight-bearing and femoral nerve block.
METHODS: We performed a retrospective cohort study in patients aged ≥ 70 years with acute hip fracture consecutively admitted to a tertiary Swiss hospital between January 1, 2023 and December 31, 2023 (n = 100). Patients meeting eligibility criteria (≥ 3 geriatric syndromes, no severe dementia) received OMC (n = 46) including an intensive multiprofessional rehabilitation program (MRP) comprising 7 physical, 2 nutritional, and 1 occupational therapy sessions led by a geriatrician during the acute hospital stay. All other patients received routine care (n = 56) on the same acute ward led by an orthopedic surgeon. Discharge destination, adherence to nine pre-specified clinical care standards and functional outcomes (Barthel index [BI] and De Morton Mobility index [DEMMI]), were assessed.
RESULTS: Mean age was 83.6 years, 59% were female, and 66% frail (Clinical Frailty Scale ≥ 5). Overall, 30 patients (65.2%) in the OMC were discharged to inpatient geriatric rehabilitation compared to 15 patients (27.8%) in routine care. After post-acute rehabilitation, 23 patients (50%) in the OMC versus 16 patients (29.6%) in routine care were discharged home. Length of stay was similar in the OMC versus routine care (10.8 vs. 9.4 days). Mean adherence to nine clinical care standards was 87.9% in the OMC versus 58.7% in routine care. In OMC patients, adherence was lowest for pain management using a femoral nerve block (58.7%), and full-weight bearing (76.1%), while full adherence was observed for mobilization the first day after surgery. In the OMC, functional outcomes improved within 7 days (median increase BI 10 points, DEMMI 8 points).
CONCLUSIONS: The OMC including MRP resulted in higher numbers discharged to post-acute rehabilitation and to home afterwards, as well as improvement of adherence to clinical care standards and functional outcomes, suggesting that OMC is a promising care model. Refinement of OMC is needed to optimize adherence to full weight-bearing and femoral nerve block.