230
· 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.