Effect of Orthogeriatric Co-Management on Geriatric Hip Fractures in China

Abstract

Objectives: Although geriatric hip fracture is a serious public health problem in China, the result of orthogeriatric co-management (OGC) is rarely reported. This study aimed to evaluate the effect of OGC in Chinese patients aged ≥65 years. Methods: In this single-centre, pre-post intervention, retrospective study, traditional orthopaedic care (TOC) was used until OGC was implemented in May 2015, a multidisciplinary team was organized, and clinical protocol was designed. Consecutive hip fracture patients who were ≥65 years and injured within 3 weeks were included in this study. Demographic characteristics, comorbidities, fracture patterns, surgical procedure, time to surgery, length of hospital stay, inpatient complications, and in-hospital mortality were extracted and examined. At 1-year after surgery, data on patients' mobility and mortality were collected. The time to surgery, incidence of inpatient complications, mortality and functional outcomes were compared between the groups. Results: There were no significant differences in sex, fracture type, and surgical pattern between OGC (n = 434) and TOC (n = 452) groups. Patients in OGC group were significantly older (P < 0.001) and had a higher age-adjusted Charlson comorbidity index (P < 0.001). However, waiting time between admission and operation was significantly lower in OGC group (P < 0.001). There was no significant difference in the mortality rate at the time of the patient being in-hospital and at 1, 3, and 6 months after surgery. Although 1-year mortality was higher in OGC group (P = 0.036), Cox regression analysis showed no significant correlation of OGC with 1-year mortality. There was no significant difference in pre-injury mobility and 1-year follow-up mobility assessed by Parker score. Only approximately half of the patients in both groups completely returned to their pre-injury mobility level. Conclusion: OGC significantly shortens time to surgery for geriatric hip fractures compared with TOC. However, there is no significant effect on mortality rate within 1 year and functional status at 1 year of follow-up.