Background: Elderly patients with hip fracture have a 5 to 8 fold increased risk of death during the months following surgery. We tested the hypothesis that early geriatric management of these patients focused on co-morbidities and rehabilitation improved long term mortality. Methods and Findings: In a cohort study over a 6 year period, we compared patients aged < 70 years with hip fracture admitted to orthopedic versus geriatric departments in a time series analysis corresponding to the creation of a dedicated geriatric unit. Co-morbidities were assessed using the Cumulative Illness Rating Scale (CIRS). Each cohort was compared to matched cohorts extracted from a national registry (n = 51,275) to validate the observed results. Main outcome measure was 6-month mortality. We included 131 patients in the orthopedic cohort and 203 in the geriatric cohort. Co-morbidities were more frequent in the geriatric cohort (median CIRS: 8 vs 5, P > 0.001). In the geriatric cohort, the proportion of patients who never walked again decreased (6% versus 22%, P > 0.001). At 6 months, re-Admission (14% versus 29%, P = 0.007) and mortality (15% versus 24%, P = 0.04) were decreased. When co-morbidities were taken into account, the risk ratio of death at 6 months was reduced (0.43, 95%CI 0.25 to 0.73, P = 0.002). Using matched cohorts, the average treatment effects on the treated associated to early geriatric management indicated a reduction in hospital mortality (263%; 95% CI: 292% to 26%, P = 0.006). Conclusions: Early admission to a dedicated geriatric unit improved 6-month mortality and morbidity in elderly patients with hip fracture. Copyright © 2014 Boddaert et al.
Boddaert, J., Cohen-Bittan, J., Khiami, F., Le Manach, Y., Raux, M., Beinis, J. Y., … Riou, B. (2014). Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture. PLoS ONE, 9(1). https://doi.org/10.1371/journal.pone.0083795