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· DOS Abstracts

Orthogeriatrics Didn’t Improve Mortality in

Patients with a Hip Fracture Admitted from

Nursing Homes

Charlotte Packroff Stenqvist, Susanne van der Mark

Department of Orthopedic Surgery, Bispebjerg Hospital; Department of

Orthopedic Surgery, Bispebjerg Hospital

Background:

Important predictors for death in frail hip fracture patients are

anemia, cognitive impairment, prolonged delirium, post- operative infections

and age ≥ 85 years. Admittance from a nursing home, a high- ASA score, and

frailty have also been shown to be independent predictors of mortality.

Purpose / Aim of Study:

The purpose of this study is to evaluate the effect of

Orthogeriatrics at nursing home residents admitted with a hip fracture. Primary

outcome is mortality in-hospital and after one, three and 12 months.

Materials and Methods:

This is a retrospective clinical cohort study. The in-

tervention group consists of all patients admitted from December 1, 2009 to

December 1, 2011 (n= 993). The historic control group was admitted from

June 1, 2007 to June 1, 2009 before the implementation of orthogeriatrics

(n=989). If patients were admitted twice during the study period due to bilat-

eral fractures, second admission was not included. There were no other exclu-

sion criteria or any randomization.

Findings / Results:

Our data show significantly increasing ASA scores over

time reflecting increasing frailty and comorbidity among the hip fracture pa-

tients. In our intervention group, a multivariate analysis correcting for age, gen-

der, and ASA score shows significantly reduced mortality as well in-hospital (OR

0.35), as after 30 (OR 0.66) and 90 days (OR 0.72) and 1-year (OR 0.79)

despite only 50% of the group having received geriatric assessment. Patients

from nursing homes had no significant decreasing mortality at any time. Our

intervention population consists of 23% (218/928) nursing home residents.

Conclusions:

There has been a tradition to discharge nursing home residents

early, but the increasing comorbidity among these patients and decreasing skills

at the step down facilities call for a change in management for these weak pa-

tients.

No conflicts of interest reported

181.