Antonio De Vincentis1, Astrid Ursula Behr2, Giuseppe Bellelli3,4, Marco Bravi5, Anna Castaldo6, Lucia Galluzzo7, Giovanni Iolascon8, Stefania Maggi9, Emilio Martini10, Alberto Momoli11, Graziano Onder7, Marco Paoletta8, Luca Pietrogrande12, Mauro Roselli13, Mauro Ruggeri14, Carmelinda Ruggiero15, Fabio Santacaterina5, Luigi Tritapepe16, Amedeo Zurlo17, Raffaele Antonelli Incalzi18. 1. Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, 00128, Rome, Italy. 2. Operative Unit of Anesthesia and Resuscitation, Hospital of Camposampiero, Padua, Italy. 3. Acute Geriatric and Orthogeriatric Unit, S. Gerardo Hospital, Monza, Italy. 4. Milano-Bicocca University, Milan, Italy. 5. Physical and Rehabilitation Medicine Department, Campus Bio-Medico University of Rome, Rome, Italy. 6. Bachelor of Nursing, IRCCS SMN Fondazione Don Gnocchi, University of Milan, Milano, Italy. 7. Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy. 8. Department of Medical and Surgical Specialties and Dentistry, University of Campania 'Luigi Vanvitelli', Naples, Italy. 9. Institute of Neuroscience, Aging Branch, CNR, Padua, Italy. 10. Orthogeriatric Unit, Azienda Ospedaliero Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy. 11. Orthopedic and Traumatology Unit, San Bortolo Hospital, Vicenza, Italy. 12. Orthopedy and Traumatology, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan Medical School, Milan, Italy. 13. Orthopedic and Traumatology Unit, 'Maria Vittoria' Hospital, Torino, Italy. 14. Società Italiana di Medicina Generale (SIMG), Firenze, Italy. 15. Orthogeriatric Unit, Geriatric Unit, Section of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia, Italy. 16. Operative Unit of Anesthesia and Intensive Care Medicine, San Camillo-Forlanini Hospital, Rome, Italy. 17. Geriatric and Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy. 18. Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, 00128, Rome, Italy. r.antonelli@unicampus.it.
Abstract
BACKGROUND: Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM: To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS: A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS: A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION: These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
BACKGROUND: Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM: To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS:A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS: A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION: These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
Authors: Antonio De Vincentis; Astrid Ursula Behr; Giuseppe Bellelli; Marco Bravi; Anna Castaldo; Claudio Cricelli; Lucia Galluzzo; Giovanni Iolascon; Stefania Maggi; Emilio Martini; Alberto Momoli; Graziano Onder; Marco Paoletta; Mauro Roselli; Mauro Ruggeri; Fabio Santacaterina; Luigi Tritapepe; Amedeo Zurlo; Raffaele Antonelli Incalzi Journal: Aging Clin Exp Res Date: 2020-05-01 Impact factor: 3.636
Authors: Kaushik Mukherjee; Steven E Brooks; Robert D Barraco; John J Como; Franchesca Hwang; Bryce R H Robinson; Marie L Crandall Journal: J Trauma Acute Care Surg Date: 2020-02 Impact factor: 3.313
Authors: C Kammerlander; T Roth; S M Friedman; N Suhm; T J Luger; U Kammerlander-Knauer; D Krappinger; M Blauth Journal: Osteoporos Int Date: 2010-11-06 Impact factor: 4.507
Authors: Maria Cristina Ferrara; Anita Andreano; Elena Tassistro; Piero Rapazzini; Amedeo Zurlo; Stefano Volpato; Chiara Mussi; Maurizio Corsi; Maria Lia Lunardelli; Emilio Martini; Giuseppe Castoldi; Francesco De Filippi; Monica Pizzonia; Fiammetta Monacelli; Antonella Barone; Alberto Pilotto; Albert March; Andrea Ungar; Roberto Capelli; Valter Galmarini; Simone Franzoni; Flavio Terragnoli; Angelo Bianchetti; Ilaria Cazzulani; Chiara Gandossi; Maria Grazia Valsecchi; Giuseppe Bellelli Journal: Aging Clin Exp Res Date: 2020-02-05 Impact factor: 3.636
Authors: Patrick Haentjens; Jay Magaziner; Cathleen S Colón-Emeric; Dirk Vanderschueren; Koen Milisen; Brigitte Velkeniers; Steven Boonen Journal: Ann Intern Med Date: 2010-03-16 Impact factor: 25.391
Authors: Bheeshma Ravi; Richard Jenkinson; Peter C Austin; Ruth Croxford; David Wasserstein; Benjamin Escott; J Michael Paterson; Hans Kreder; Gillian A Hawker Journal: BMJ Date: 2014-05-23