Does orthogeriatric co-management improve clinical outcomes in patients aged 75 and older undergoing surgical treatment for proximal femoral fractures?
Orthogeriatric co-management for proximal femoral fractures in elderly patients significantly reduces hospital length of stay without impacting mortality, readmission, or revision rates.
Background: Surgically treated proximal femoral fractures in geriatric patients are a major debilitating condition, with continuously rising numbers, impacting patients and the healthcare system. Models of care based on orthogeriatric co-management (OGCM) have suggested promising clinical outcomes compared with the standard of care (SOC) model in the treatment of frail elderly patients. Methods: A retrospective cohort study investigating clinical outcomes in two comparable cohorts of patients aged 75 and older, who underwent surgical treatment for proximal femoral fractures in 2023 was conducted. Included individuals all originated from the same geographic area, therefore presenting a unique cohort. The cohorts were differentiated by the perioperative care protocols implemented: an OGCM protocol (n = 147) versus a SOC protocol (n = 143). The main outcome measures were readmission, revision, and mortality rates at 30 days and one-year post-surgery, as well as the length of hospital stay. Results: Findings revealed a positive impact for patients treated under the OGCM protocol, with a significant reduction in the length of hospital stay (6 vs. 7 days, p = 0.001), while no consistent differences were observed in readmission (36.2% vs. 39.7%, p = 0.676), surgical revision (8.4% vs. 12.4%, p = 0.485), and mortality (24.1% vs. 31.7%, p = 0.781) rates one-year after surgery. Conclusions: Despite the absence of significant differences in major outcomes such as mortality, readmission, and surgical revision between the two protocols, the implementation of a more resource-intensive multidisciplinary care pathway resulted in a significant reduction in hospital length of stay. Beyond its clinical value, this improvement may contribute to reducing the burden on healthcare staff and support the sustainability of hospital systems facing increasing pressure.
Känel et al. (Wed,) studied this question.