Orthogeriatric co-management and incident nursing home admissions in older patients with fragility fractures other than the hip-a retrospective cohort study using insurance claims data from Germany.

BACKGROUND

Orthogeriatric co-management (OGCM) has been proposed as care model for geriatric patients with fragility fractures. However, its impact on nursing home (NH) admissions following non-hip fractures is unclear. This study aims to assess the association between OGCM and the probability of NH admissions within 6 months in older patients with fragility fractures other than the hip.

METHODS

This retrospective cohort study utilized nationwide insurance claims data from Germany (from years 2014-2018), covering individuals aged 80 years or older with fractures of the humerus, forearm, pelvis, or vertebrae. Based on the number of OGCM claims per year, hospitals were categorized as either OGCM or no OGCM. The primary outcome was the incidence of NH admissions within 6 months of the index fracture. Quasi-Poisson regression models were used to calculate incidence rate ratios (IRRs) with 95% confidence intervals (CI), adjusted for age, sex, prior care needs, comorbidity score, and rehabilitation transfer rates.

RESULTS

A total of 106,217 patients were included in the analysis. The incidence of NH admissions varied by fracture site, ranging from 11.1% for pelvic to 24.7% for vertebrae fractures, respectively. OGCM was associated with a reduced probability of NH admissions for humerus fractures (IRR 0.94, 95% CI 0.88-1.00) and vertebral fractures (IRR 0.92, 95% CI 0.87-0.97). No statistically significant associations were found for forearm (IRR 1.06, 95% CI 0.97-1.15) or pelvic fractures (IRR 1.02, 95% CI 0.96-1.09).

CONCLUSIONS

OGCM went along with a reduced probability of NH admissions in geriatric patients with humerus and vertebral fractures but showed no statistically significant benefit for forearm or pelvic fractures. The results highlight the need for targeted OGCM strategies based on fracture type and patient demographics to optimize outcomes in this vulnerable population.