Proximal Hip Fracture: A Comparison of Orthopedic and Geriatric Care Models
2Geriatric Department, Barzilai Medical Center, Israel
Introduction:
Orthogeriatric patients with proximal femur fractures have multiple comorbidities, disabilities, increasing healthcare cost and burden, and associated with increased morbidity and mortality. The standard approach is hospitalization orthopedics with geriatric consultations based on the demand. The new approach indicates that most patients should be hospitalized in the geriatric department, with daily orthopedic follow-up. Orthogeriatric co-management, dual care may improve the overall outcomes. Our study aimed to compare hospitalization in the two departments to improve the outcome, the quality standards of care and make the needed changes to the healthcare system.
Methods:
285 patients with proximal hip fractures, admitted to the emergency department between October 2019 and December 2020. The study group was divided into two models based on hospitalization in orthopedics and geriatrics departments. Demographic data, along with post-operative outcomes such as discharge destination, length of hospitalization, and mortality, were measured. The excluded 26 patients conservatively treated had also been analyzed.
Results:
253 patients had surgery, geriatric patients were significantly older, had higher comorbidities, extended hospitalization, and higher mortality during hospitalization, 30-days, and 1-year follow-up (p<0.05). At the end of the hospitalization, significantly higher rates of geriatric patients had been discharged to home rehabilitation than from orthopedics (17.5% vs. 7.4%; p<0.01). Among non-operated patients, mortality was 57.7% versus 16.5 in patients that underwent surgery during 1-year of follow-up.
Discussion:
Our study showed a tendency to hospitalize older patients with comorbidities in the geriatric department rather than in the orthopedic ward. The average hospitalization in the geriatrics was 3.6 days longer, but patients had been released to home rehabilitation in greater percentage than from orthopedics. Ortho-geriatric collaboration improves the quality of care, hospitalization of patients with hip fractures in the geriatric department with daily orthopedic follow-up provides a better standard of care and aims in the long run rehabilitation process.