Mary Anderson Wallace1, Andrew Hammes2, Micol S Rothman3, Anastasiya A Trizno4, Christine D Jones1, Ethan Cumbler1, Kelly McDevitt5, Nichole E Carlson2, Jason W Stoneback4. 1. Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora. 2. Department of Biostatistics and Informatics, University of Colorado, Aurora. 3. Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora. 4. Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora. 5. University of Colorado Health, Longs Peak Hospital, Longmont.
Abstract
CONTEXT: Geriatric hip fractures are increasingly common and confer substantial morbidity and mortality. Fragmentation in geriatric hip fracture care remains a barrier to improved outcomes. OBJECTIVE: To evaluate the impact of a comprehensive geriatric hip fracture program on long-term mortality. DESIGN: We conducted a retrospective cohort study of patients aged 65 years and older admitted to our academic medical center between January 1, 2012, and March 31, 2016 with an acute fragility hip fracture. Mortality data were obtained for in-state residents from the state public health department. MAIN OUTCOME MEASURES: Mortality within 1 year of index admission and overall survival based on available follow-up data. RESULTS: We identified 243 index admissions during the study period, including 135 before and 108 after program implementation in October 2014. The postintervention cohort trended toward a lower unadjusted 1-year mortality rate compared with the preintervention cohort (15.7% vs 24.4%, p = 0.111), as well as lower adjusted mortality at 1 year (relative risk = 0.73, 95% confidence interval = 0.46-1.16, p = 0.18), although the differences were not statistically significant. The postintervention cohort had significantly higher overall survival than did the preintervention cohort (hazard ratio for death = 0.43, 95% confidence interval = 0.25-0.74, p = 0.002). CONCLUSION: Fixing fragmentation in geriatric hip fracture care such as through an orthogeriatric model is essential to improving overall survival for this patient population.
CONTEXT: Geriatric hip fractures are increasingly common and confer substantial morbidity and mortality. Fragmentation in geriatric hip fracture care remains a barrier to improved outcomes. OBJECTIVE: To evaluate the impact of a comprehensive geriatric hip fracture program on long-term mortality. DESIGN: We conducted a retrospective cohort study of patients aged 65 years and older admitted to our academic medical center between January 1, 2012, and March 31, 2016 with an acute fragility hip fracture. Mortality data were obtained for in-state residents from the state public health department. MAIN OUTCOME MEASURES: Mortality within 1 year of index admission and overall survival based on available follow-up data. RESULTS: We identified 243 index admissions during the study period, including 135 before and 108 after program implementation in October 2014. The postintervention cohort trended toward a lower unadjusted 1-year mortality rate compared with the preintervention cohort (15.7% vs 24.4%, p = 0.111), as well as lower adjusted mortality at 1 year (relative risk = 0.73, 95% confidence interval = 0.46-1.16, p = 0.18), although the differences were not statistically significant. The postintervention cohort had significantly higher overall survival than did the preintervention cohort (hazard ratio for death = 0.43, 95% confidence interval = 0.25-0.74, p = 0.002). CONCLUSION: Fixing fragmentation in geriatric hip fracture care such as through an orthogeriatric model is essential to improving overall survival for this patient population.
Authors: Michael P Phy; David J Vanness; L Joseph Melton; Kirsten Hall Long; Cathy D Schleck; Dirk R Larson; Paul M Huddleston; Jeanne M Huddleston Journal: Arch Intern Med Date: 2005-04-11
Authors: David J Becker; Tarun Arora; Meredith L Kilgore; Jeffrey R Curtis; Elizabeth Delzell; Kenneth G Saag; Huifeng Yun; Michael A Morrisey Journal: J Aging Health Date: 2014-01-08
Authors: David González Quevedo; Iskandar Tamimi Mariño; Juan Manuel Sánchez Siles; Esther Romero Escribano; Esther Judith Granero Molina; David Bautista Enrique; Tomislav Smoljanović; Francisco Villanueva Pareja Journal: Injury Date: 2017-06-20 Impact factor: 2.586
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