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J Orthop Trauma. 2006 Mar;20(3):172-8; discussion 179-80.

Outcomes for older patients with hip fractures: the impact of orthopedic and geriatric medicine cocare.

Author information

1
Department of Geriatric Medicine, ACT, Australia. alex.fisher@act.gov.au

Abstract

OBJECTIVES:

To assess the impact of a specifically designed model of orthopedic-geriatric cocare on hip fracture (HF) outcomes.

SETTING:

Tertiary teaching hospital (level I trauma center).

DESIGN:

Prospective observational study with a retrospective (historical) control. Data on 951 consecutive patients 60 years of age or older admitted to the authors' institution with a nonpathologic HF over a 7-year period (1995 to 2002) were analyzed. Between 1995 and 1997, medical problems were managed by a geriatric medicine (GM) consultation-only service (retrospective audit). In 1998, a GM registrar began overseeing daily medical care with weekly geriatrician consultant review (prospective study). Outcomes for 2 time periods were compared: a 3-year period before (no GM; 504 patients) and a 4-year period after (GM; 447 patients) the introduction of GM cocare.

MAIN OUTCOME MEASUREMENTS:

Postoperative medical complications, mortality, length of stay, discharge destination, use of thromboprophylaxis, and antiosteoporotic treatment.

RESULTS:

While comparing 2 periods (GM and no GM), significant reductions in postoperative medical complications and comorbid conditions (in total 49.5% vs. 71.0%, P<0.001) and mortality (4.7% vs. 7.7%, P<0.01) occurred and rehospitalization to medical wards within 6 months decreased (28% vs. 7.6%). However, no differences were observed in median length of hospital stay (10.8 vs. 11.0 days) or in discharge destination. Antiosteoporotic treatment (12% to 69%) and specific thromboprophylaxis (63% to 94%) increased in the GM period.

CONCLUSIONS:

Orthopedic-geriatric cocare for the older patients with HF was associated with significant reductions in morbidity and mortality, and increases in optimal postoperative care. Options for further improvement of orthopedic-GM cocare need to be investigated.

[Indexed for MEDLINE]

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