M Knobe1, B Böttcher2, M Coburn3, T Friess4, L C Bollheimer5, H J Heppner6, C J Werner7, J-P Bach7, M Wollgarten2, S Poßelt8, C Bliemel9, B Bücking9. 1. Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. mknobe@ukaachen.de. 2. Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. 3. Klinik für Anästhesiologie, Uniklinik RWTH Aachen, Aachen, Deutschland. 4. Klinik für Unfall- und Handchirurgie, Zentrum für Alterstraumatologie im St. Clemens-Hospital Oberhausen, Oberhausen, Deutschland. 5. Lehrstuhl für Altersmedizin, RWTH Aachen mit Klinik für Innere Medizin und Geriatrie am Franziskushospital Aachen, Aachen, Deutschland. 6. Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, Universität Witten/Herdecke, Witten, Deutschland. 7. Klinik für Neurologie, Sektion Interdisziplinäre Geriatrie, Uniklinik RWTH Aachen, Aachen, Deutschland. 8. Kaufmännisches Controlling, Uniklinik RWTH Aachen, Aachen, Deutschland. 9. Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Marburg, Deutschland.
Abstract
BACKGROUND: Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. OBJECTIVE: The aim of the current prospective cohort study was the clinical and economic evaluation of fragility fracture treatment pathways before and after the implementation of a geriatric trauma center in conformity with the guidelines of the German Trauma Society (DGU). METHODS: A comparison of three different treatment models (6 months each) was performed: A: Standard treatment in Orthopaedic Trauma; B: Special care pathways with improvement of the quality management system and implementation of standard operating procedures; C: Interdisciplinary treatment with care pathways and collaboration with geriatricians (ward round model). RESULTS: In the 151 examined patients (m/w 47/104; 83.5 (70-100) years; A: n = 64, B: n = 44, C: n = 43) pathways with orthogeriatric comanagement (C) improved frequency of postoperative mobilization (p = 0.021), frequency of osteoporosis prophylaxis (p = 0.001) and the discharge procedure (p = 0.024). In comparison to standard treatment (A), orthogeriatric comanagement (C) was associated with lower rates of mortality (9% vs. 2%; p = 0.147) and cardio-respiratory complications (39% vs. 28%; p = 0.235) by trend. In this context, there were low rates of myocardial infarction (6% vs. 0%), dehydration (6% vs. 0%), cardiac dysrhythmia (8% vs. 0%), pulmonary decompensation (28% vs. 16%), electrolyt dysbalance (34% vs. 19%) and pulmonary edema (11% vs. 2%). Duration of stay in an intensive care unit was 29 h (A) and 18 h (C) respectively (p = 0.205), with consecutive reduction in costs. A sole establishment of a special care pathway for older hip fracture patients (B) showed a lower rate of myocardial infarction (A: 11%, B: 0%, C: 0%; p = 0.035). CONCLUSION: There was a clear tendency to a better overall result in patients receiving multidisciplinary orthogeriatric treatment using a ward visit model of orthogeriatric comanagement, with lower rates of cardiorespiratory complications and mortality. While special care pathways could reduce the rate of myocardial infarction in hip fracture patients, costs and revenues showed no difference between all care models evaluated. However, patients with hip fracture or periprosthetic fracture represent cohorts at clinical and economic risk as well.
BACKGROUND: Previous studies on orthogeriatric models of care suggest that there is substantial variability in how geriatric care is integrated in the patient management and the necessary intensity of geriatric involvement is questionable. OBJECTIVE: The aim of the current prospective cohort study was the clinical and economic evaluation of fragility fracture treatment pathways before and after the implementation of a geriatric trauma center in conformity with the guidelines of the German Trauma Society (DGU). METHODS: A comparison of three different treatment models (6 months each) was performed: A: Standard treatment in Orthopaedic Trauma; B: Special care pathways with improvement of the quality management system and implementation of standard operating procedures; C: Interdisciplinary treatment with care pathways and collaboration with geriatricians (ward round model). RESULTS: In the 151 examined patients (m/w 47/104; 83.5 (70-100) years; A: n = 64, B: n = 44, C: n = 43) pathways with orthogeriatric comanagement (C) improved frequency of postoperative mobilization (p = 0.021), frequency of osteoporosis prophylaxis (p = 0.001) and the discharge procedure (p = 0.024). In comparison to standard treatment (A), orthogeriatric comanagement (C) was associated with lower rates of mortality (9% vs. 2%; p = 0.147) and cardio-respiratory complications (39% vs. 28%; p = 0.235) by trend. In this context, there were low rates of myocardial infarction (6% vs. 0%), dehydration (6% vs. 0%), cardiac dysrhythmia (8% vs. 0%), pulmonary decompensation (28% vs. 16%), electrolyt dysbalance (34% vs. 19%) and pulmonary edema (11% vs. 2%). Duration of stay in an intensive care unit was 29 h (A) and 18 h (C) respectively (p = 0.205), with consecutive reduction in costs. A sole establishment of a special care pathway for older hip fracturepatients (B) showed a lower rate of myocardial infarction (A: 11%, B: 0%, C: 0%; p = 0.035). CONCLUSION: There was a clear tendency to a better overall result in patients receiving multidisciplinary orthogeriatric treatment using a ward visit model of orthogeriatric comanagement, with lower rates of cardiorespiratory complications and mortality. While special care pathways could reduce the rate of myocardial infarction in hip fracturepatients, costs and revenues showed no difference between all care models evaluated. However, patients with hip fracture or periprosthetic fracture represent cohorts at clinical and economic risk as well.
Authors: Konrad Schuetze; Alexander Eickhoff; Kim-Sarah Rutetzki; Peter H Richter; Florian Gebhard; Christian Ehrnthaller Journal: Eur J Trauma Emerg Surg Date: 2020-08-31 Impact factor: 3.693
Authors: Markus Gosch; Christian Kammerlander; Emilio Fantin; Thomas Giver Jensen; Ana Milena López Salazar; Carlos Olarte; Suthorn Bavatonavarech; Claudia Medina; Bjoern-Christian Link; Michael Cunningham Journal: Geriatr Orthop Surg Rehabil Date: 2021-03-31
Authors: Sascha Halvachizadeh; Lea Gröbli; Till Berk; Kai Oliver Jensen; Christian Hierholzer; Heike A Bischoff-Ferrari; Roman Pfeifer; Hans-Christoph Pape Journal: PLoS One Date: 2021-01-11 Impact factor: 3.240