Marco Quaranta1,2, Luca Miranda1,2, Francesco Oliva1,2, Filippo Migliorini3, Gabriela Pezzuti2, Nicola Maffulli1,2,4,5. 1. Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy. 2. Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, 84131, Salerno, Italy. 3. Department of Orthopedic and Trauma Surgery, RWTH University Clinic Aachen, Pauwelsstr. 31, 52074, Aachen, Germany. fmigliorini@ukaachen.de. 4. Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England. 5. Guy Hilton Research Centre, Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England.
Abstract
BACKGROUND: Hip fractures are common in elderly patients, in whom it is important to monitor blood loss; however, unnecessary transfusions should be avoided. The primary objective of this study was to assess whether the employment of a dedicated orthogeriatrician in an Orthopaedic Department allows to optimise the clinical conditions of patients, influencing blood loss and consequently the number of transfusions. The secondary objective was to determine whether the influence of the orthogeriatrician differs according to the type of surgical treatment. METHODS: A total of 620 elderly patients treated for hip fracture were included in the study. These patients were divided into two groups according to the presence or not of the orthogeriatrician. For each patient, age, sex, comorbidities, type of fracture, surgical treatment, length of hospital stay, time from hospitalisation and surgery, time from surgery to discharge, haemoglobin (Hb) values (admission, 24h post-surgery, lowest Hb reached, discharge) and the number of transfusions were recorded. RESULTS: Regardless of the surgical procedure performed, in patients managed by the orthogeriatrician, the Hb at discharge was significantly higher (p = 0.003). In addition to the highest Hb at discharge, in patients who underwent hemiarthroplasty, the number of transfusions per patient is significantly reduced (p = 0.03). CONCLUSION: The introduction of the orthogeriatrician in an orthopaedic ward for the management of elderly patients treated for hip fracture allows to discharge the patients with higher Hb values, reducing the risk of anemisation and the costs related to possible re-admission.
BACKGROUND:Hip fractures are common in elderly patients, in whom it is important to monitor blood loss; however, unnecessary transfusions should be avoided. The primary objective of this study was to assess whether the employment of a dedicated orthogeriatrician in an Orthopaedic Department allows to optimise the clinical conditions of patients, influencing blood loss and consequently the number of transfusions. The secondary objective was to determine whether the influence of the orthogeriatrician differs according to the type of surgical treatment. METHODS: A total of 620 elderly patients treated for hip fracture were included in the study. These patients were divided into two groups according to the presence or not of the orthogeriatrician. For each patient, age, sex, comorbidities, type of fracture, surgical treatment, length of hospital stay, time from hospitalisation and surgery, time from surgery to discharge, haemoglobin (Hb) values (admission, 24h post-surgery, lowest Hb reached, discharge) and the number of transfusions were recorded. RESULTS: Regardless of the surgical procedure performed, in patients managed by the orthogeriatrician, the Hb at discharge was significantly higher (p = 0.003). In addition to the highest Hb at discharge, in patients who underwent hemiarthroplasty, the number of transfusions per patient is significantly reduced (p = 0.03). CONCLUSION: The introduction of the orthogeriatrician in an orthopaedic ward for the management of elderly patients treated for hip fracture allows to discharge the patients with higher Hb values, reducing the risk of anemisation and the costs related to possible re-admission.
Entities:
Keywords:
Elderly patients; Haemoglobin; Hip fractures; Interdisciplinary management; Orthogeriatrician; Transfusions
Authors: Antoine Meunier; Alexandre Maczynski; Sanaa Asgassou; Emmanuel Baulot; Patrick Manckoundia; Pierre Martz Journal: Geriatr Psychol Neuropsychiatr Vieil Date: 2019-06-01