Elderly adults with isolated hip fractures- orthogeriatric care versus standard care: A practice management guideline from the Eastern Association for the Surgery of Trauma

• Published in: The journal of trauma and acute care surgery Vol. 88; no. 2; pp. 266 - 278
• Main Authors: Mukherjee, Kaushik, Brooks, Steven E., Barraco, Robert D., Como, John J., Hwang, Franchesca, Robinson, Bryce R. H., Crandall, Marie L.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-02-2020
• Subjects: Age Factors; Aged; Aged, 80 and over; Geriatric Assessment; Geriatrics - methods; Geriatrics - standards; Hip Fractures - mortality; Hip Fractures - therapy; Humans; Orthopedics - methods; Orthopedics - standards; Patient Care Team - standards; Practice Guidelines as Topic; Societies, Medical - standards; Standard of Care; Traumatology - standards; Treatment Outcome
• ISSN: 2163-0755; 2163-0763
• DOI: 10.1097/TA.0000000000002482

Elderly patients commonly suffer isolated hip fractures, causing significant morbidity and mortality. The use of orthogeriatrics (OG) management services, in which geriatric specialists primarily manage or co-manage patients after admission, may improve outcomes. We sought to provide recommendations regarding the role of OG services.
Using GRADE methodology with meta-analyses, the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma conducted a systematic review of the literature from January 1, 1900, to August 31, 2017. A single Population, Intervention, Comparator and Outcome (PICO) question was generated with multiple outcomes: Should geriatric trauma patients 65 years or older with isolated hip fracture receive routine OG management, compared with no-routine OG management, to decrease mortality, improve discharge disposition, improve functional outcomes, decrease in-hospital medical complications, and decrease hospital length of stay?
Forty-five articles were evaluated. Six randomized controlled trials and seven retrospective case-control studies met the criteria for quantitative analysis. For critical outcomes, retrospective case-control studies demonstrated a 30-day mortality benefit with OG (OR, 0.78 [0.67, 0.90]), but this was not demonstrated prospectively or at 1 year. Functional outcomes were superior with OG, specifically improved score on the Short Physical Performance Battery at 4 months (mean difference [MD], 0.78 [0.28, 1.29]), and improved score on the Mini Mental Status Examination with OG at 12 months (MD, 1.57 [0.40, 2.73]). Execution of activities of daily living was improved with OG as measured by two separate tests at 4 and 12 months. There was no difference in discharge disposition. Among important outcomes, the OG group had fewer hospital-acquired pressure ulcers (OR, 0.30 [0.15, 0.60]). There was no difference in other complications or length of stay. Overall quality of evidence was low.
In geriatric patients with isolated hip fracture, we conditionally recommend an OG care model to improve patient outcomes.
Systematic review/meta-analysis, level III.