Proactive Geriatric Consultation for Elderly Orthopedic Patients Reduces Mortality and Length of Stay


Ron Cialic 1 Rotem Tellem 1 Orly Barak 1 Adi Berliner Senderey 2 Ahuva Weiss-Meilik 2 Yaffa Lerman 1 Moshe Salai 3 Nimrod Snir 3
1Geriatric Division, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
2Clinical Performance Research Unit, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
3Orthopedic Division, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel

Background: Traumatic injuries and osteoarthritis are leading causes for functional deterioration, morbidity and mortality in the older population. Following orthopedic interventions, older patients are susceptible to various medical complications - wound and systemic infections, VTE, delirium, pressure sores, and exacerbation of chronic medical conditions. Delayed identification and treatment of these complications may increase length of stay, morbidity and mortality and increases the risk for functional deterioration and unwanted institutionalization. Geriatricians are trained to perform early identification and treatment of these complications as well as to direct a multidimensional discharge plans. In the current study we made an adjustment to the standard care of older patients by employing a proactive geriatric consultation. Geriatricians served as an integral part of a multidisciplinary team providing care for older patients in the orthopedic division. The geriatricians conducted early post-operative evaluation and continued follow-up in selected patients.

Design: Retrospective single center cohort study.

Setting: Orthopedic division of a large tertiary academic hospital.

Methods: Retrospective data was collected for the years 2011-2015. (The intervention took place between 01.2015 and 31.12.2015). Time from operation to geriatric consultation, Post-operative length of stay in the orthopedic division and perioperative mortality were compared for patients during the intervention period (n=736) and previous years (n=5786).

Results: Time from operation to geriatric consultation decreased (93 hours to 67 hours median time, P <0.01), Post-operative length of stay decreased (6.8 days to 5.9 days, P value <0.01). During intervention year mortality rate was reduced significantly (38 to 34 yearly death rate, P<0.001).

Conclusion: Integrating geriatricians into the multidisciplinary orthopedic team and applying a proactive geriatric approach led to reduced length of stay and mortality.