Jip Kusen1, Puck van der Vet1, Frans-Jasper Wijdicks2, Marijn Houwert3, Marcel Dijkgraaf4, Marije Hamaker5, Olivia Geraghty6, Egbert-Jan Verleisdonk1, Detlef van der Velde7. 1. Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat Utrecht 1, 3582 KE, Utrecht, The Netherlands. 2. Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat Utrecht 1, 3582 KE, Utrecht, The Netherlands. fjwijdicks@diakhuis.nl. 3. Department of Surgery, UMC Utrecht, Utrecht, The Netherlands. 4. Department of Clinical Epidemiology, AMC Amsterdam, Amsterdam, The Netherlands. 5. Department of Geriatrics, Diakonessenhuis Utrecht, Utrecht, The Netherlands. 6. Department of Geriatrics, Antoniusziekenhuis Nieuwegein, Nieuwegein, The Netherlands. 7. Department of Surgery, Antoniusziekenhuis Nieuwegein, Nieuwegein, The Netherlands.
Abstract
PURPOSE: Hip fractures in geriatric patients have high morbidity and mortality rates. The implementation of a multidisciplinary geriatric care pathway (GCP) may improve treatment for this patient population. This study focusses on two level II hospitals with a different treatment protocols. A comparison was made between a multidisciplinary GCP and extensive standard care with a focus on geriatric hip fracture patients to assess if a multidisciplinary GCP leads to lower mortality and morbidity. METHODS: This retrospective cohort study included patients aged 70 years or older with a unilateral proximal hip fracture who underwent surgery between January 2014 and December 2015. The primary outcome measures complications and 30-day mortality. Secondary outcome measures were time to surgery, hospital length of stay (HLOS) and secondary surgical interventions. RESULTS: This study included a total of 898 patients. No differences were found between major postoperative complications, 30-day mortality, HLOS or the amount of secondary surgical interventions. CONCLUSIONS: Mortality, major complications, HLOS and the amount of secondary surgical interventions showed no differences between both hospitals. This inter-hospital comparison of two types of geriatric care models showed no outcome that favours one specific geriatric care model over another. This provides opportunities for future studies to get a better understanding of what specific factors of geriatric care models contribute most to an improvement in the treatment of this patient population and decide which approach is most cost effective.
PURPOSE:Hip fractures in geriatric patients have high morbidity and mortality rates. The implementation of a multidisciplinary geriatric care pathway (GCP) may improve treatment for this patient population. This study focusses on two level II hospitals with a different treatment protocols. A comparison was made between a multidisciplinary GCP and extensive standard care with a focus on geriatric hip fracturepatients to assess if a multidisciplinary GCP leads to lower mortality and morbidity. METHODS: This retrospective cohort study included patients aged 70 years or older with a unilateral proximal hip fracture who underwent surgery between January 2014 and December 2015. The primary outcome measures complications and 30-day mortality. Secondary outcome measures were time to surgery, hospital length of stay (HLOS) and secondary surgical interventions. RESULTS: This study included a total of 898 patients. No differences were found between major postoperative complications, 30-day mortality, HLOS or the amount of secondary surgical interventions. CONCLUSIONS: Mortality, major complications, HLOS and the amount of secondary surgical interventions showed no differences between both hospitals. This inter-hospital comparison of two types of geriatric care models showed no outcome that favours one specific geriatric care model over another. This provides opportunities for future studies to get a better understanding of what specific factors of geriatric care models contribute most to an improvement in the treatment of this patient population and decide which approach is most cost effective.
Entities:
Keywords:
Clinical pathway; Elderly; Geriatrician; Hip fracture
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