Short-term outcomes of patients with fragility hip fractures infected with SARS-CoV-2 managed in a COVID-19 referral hospital with an orthogeriatric team

OBJECTIVES@#Presence of COVID-19 infection in patients with acute fragility hip fracture complicates the decision-making process in the management of these patients. This study aims to describe outcomes of patients with coexisting fragility hip fracture and COVID-19 infection who underwent surgery.@*METHODS@#In this retrospective study, the patient database of a university hospital designated as a COVID-19 referral center with an orthogeriatric team was reviewed to determine the mortality and morbidity rates, and short-term functional outcomes of patients with coexisting COVID-19 and acute fragility hip fracture who underwent surgery.@*RESULTS@#A total of 18 patients were admitted with COVID-19 infection and acute fragility hip fracture – 12 had surgery. Mean injury-to-admission and admission-to-surgery intervals were 6.5 and 4.8 days, respectively. Most patients (91.7%) had an incidental finding of SARS-CoV-2 infection. Mean ASA score was 2.9. Arthroplasty was done in all patients with a mean operative time of 155.8 minutes and an average blood loss of 366.7 mL. Thirty-day mortality and morbidity rates were 16.7% and 33.3%, respectively. Mean EuroQoL overall health score was 79.3.@*CONCLUSION@#A multidisciplinary team approach is recommended to expedite timely surgery prior to the onset of clinical deterioration. Asymptomatic and mildly symptomatic patients with acute fragility hip fracture are candidates for urgent surgical intervention even in the presence of COVID-19 infection

Functional outcomes among geriatric fragility hip fracture patients in a developing country: A comparative study between complete and incomplete post-operative rehabilitation

@#<p style="text-align: justify;"><strong>Objective.</strong> The study compared functional outcomes among post-operative geriatric fragility hip fracture patients who received complete and incomplete rehabilitation.</p><p style="text-align: justify;"><strong>Methods.</strong> This is an ambispective cohort study of 50 acute fragility hip fractures over a 40-month period (October 2017 to November 2020) treated with either arthroplasty or internal fixation under the UP-PGH Orthogeriatric Fracture Liaison Service (FLS). Patients were contacted and interviewed through Telemedicine. They were asked to answer two questionnaires - the Modified Harris Hip Score (MHHS) and the EuroQol-5D-5L (EQ-5D-5L). The scores were tallied and used to describe and compare the post-operative functional outcomes between the two rehabilitation pathways.</p><p style="text-align: justify;"><strong>Results.</strong> Among the 50 patients included in this study, twenty-three (46%) patients underwent complete rehabilitation, while 27 (54%) underwent incomplete rehabilitation. The average corrected MHHS was at 82.5 suggesting good outcomes among all patients, with a higher-than-average outcome of 83.6 among patients who underwent complete rehabilitation, and an outcome of 75.9 among patients who underwent incomplete rehabilitation. Results to the EQ-5D--5L survey showed that a majority of patients who underwent complete rehabilitation reported having 'no problems' in terms of self-care, and anxiety or depression. However, the same group had more patients reporting 'any problems' in terms of mobility. On the other hand, a bigger proportion of patients from the incomplete rehabilitation group presented with 'any problems' in terms of usual activities. Proportions were similar for both groups in terms of pain or discomfort, with neither group having patients who reported extreme pain or discomfort.</p><p style="text-align: justify;"><strong>Conclusion.</strong> In spite of the heterogenous nature of the hip fracture population, functional outcome measures show generally good outcomes of patients under the UP-PGH Orthogeriatric FLS, with no significant difference among patients who receive complete rehabilitation from those who undergo incomplete rehabilitation. Continuing this study may better describe and differentiate the functional outcomes in order to pave the way for evidence-based protocols dedicated to providing the highest quality of care for acute fragility fracture patients.</p>

Fractura de cadera y geriatría: una unión necesaria / Hip fracture and geriatrics: a necessary union

Las personas mayores con fractura de cadera tienen un aumento del riesgo de mortalidad de 5 a 8 veces por todas las causas, y un riesgo mucho mayor de institucionalización por pérdida funcional, ya que solo el 50% de los pacientes que sobreviven, recuperan la actividad de la vida diaria previa a la fractura. Las intervenciones para prevenir dichos resultados, incluyendo una segunda fractura, se transforma en el objetivo principal en estos pacientes. El modelo de atención de ortogeriatría es un enfoque de atención multidimensional para los pacientes que sufren una fractura de cadera, que por lo general, es secundario a una caída desde su propia altura, conocida como fractura por fragilidad. Este modelo de atención desarrollado por geriatras y traumatólogos con la asistencia de un equipo multidisciplinario, incluye una evaluación integral perioperatoria y un equipo de enfermería centrada en la función premórbida del paciente, la cognición, las comorbilidades, que permite crear un plan individualizado, para ser monitorizado y asegurar su cumplimiento, los primeros dos años después de la fractura. Este esquema de trabajo ha demostrado mejorar el retorno a la función previa y la disminución de la mortalidad, con un costo reducido o un aumento de utilidad expresada en calidad de vida, por lo que es la atención más rentable para los pacientes que sufren una fractura de cadera.

Older people with hip fracture have an increased risk of mortality 5 to 8 times, for all causes and a much higher risk of institutionalization due to functional loss, because only 50% of patients who survive, recover the activity of daily life before the fracture. Interventions to prevent such results, including a second fracture, become the principal objective in these patients. The orthogeriatric care model, is a multidimensional approach for patients who suffer a hip fracture, which is usually secondary to a fall from their own height, known as a fragility fracture. This model of care developed by geriatricians and traumatologists with help of a multidisciplinary team, includes a comprehensive perioperative assessment and a nursing team focused on the premorbid patient state, cognition, comorbidities, which allows creating an individualized plan, to be monitored and ensure compliance, the first 2 years. This work scheme has been shown to improve the return of the function and the reduction of mortality at a reduced cost or an expressed utility in quality of life, making it the most cost-effective care for patients suffering from a hip fracture.

Mortalidad intrahospitalaria en adultos mayores chilenos con fractura de cadera: incidencia, causas y otros elementos de interés / Early in-hospital Mortality in Chilean Older People with Hip Fracture

INTRODUCCIÓN: Las fracturas de cadera (FC) presentan alta mortalidad. Existen escasos estudios que profundizan en la mortalidad intrahospitalaria (MIH) asociada. OBJETIVO: Describir MIH en pacientes ≥ 60 años con FC. MATERIALES Y MÉTODOS: Corte transversal, descriptivo y analítico, monocéntrico, de colección completa. Fueron evaluados 647 sujetos, de ambos géneros, ingresados con FC entre 01.01.2010 y 31.12.2012, agrupándolos en fallecidos y egresados vivos. Se registró fallecimientos, género, edad, ubicación anatómica, tipo de traumatismo, lugar de ocurrencia de FC, tiempo fractura-fallecimiento, tiempo de estancia hospitalaria, porcentaje de operados, diagnósticos asociados a FC, diagnóstico de fallecimiento, comorbilidad asociada al diagnóstico de fallecimiento y lugar de fallecimiento. Datos en planilla ortogeriátrica, análisis descriptivo. RESULTADOS: MIH = 3,09%. Edad promedio 84 años. Los diagnósticos de fallecimiento más importantes fueron infecciones (40%) y enfermedad tromboembólica (15%). El 80% presentó comorbilidad crónica relacionada con la causa de fallecimiento. Sin diferencias significativas según edad, género, ubicación anatómica de la FC, lugar de ocurrencia de la FC, tiempo de estancia hospitalaria. Hubo diferencias significativas en cantidad de no operados, mayor en el grupo con MIH (p < 0.000), esperable por sesgo de selección. Es deseable identificar precozmente los sujetos con FC que presentan alto riesgo de MIH. Esto, para definir manejo conservador, optimizar calidad de vida y recursos hospitalarios.

INTRODUCTION: Hip fractures (HIF), have high rates of early mortality. However, there are few studies that deepen in in-hospital mortality (IHM). OBJETIVE: To describe IHM in patients with ≥ 60 years with HIF. MATERIALS AND METHODS: Cross-sectional, descriptive and analytical, monocentric, full collection. 647 subjects, both genders, admitted with HIF between 01.01.2010 and 12.31.2012, separating them in inhospital deceased and discharged alive. Registered deaths, gender, age, anatomic location, type of trauma, place of occurrence of HIF, time fracture-death, length of hospital stay, percentage of operated, diagnosis associated with HIF, diagnosis of death, comorbidity associated with the diagnosis of death and place of death. Data in orthogeriatric chart, descriptive analysis. RESULTS: IHM = 3.09%. Average age 84 years. The most important diagnoses of death were infections (40%) and thromboembolic disease (15%). 80% presented chronic comorbidity related to the cause of death. There were no significant differences according to age, gender, HIF anatomical location, place of occurrence of the HIF, length of hospital stay. There were significant differences in the number of non-operated, higher in the IHM group (p < 0.000), expected for selection bias. It is desirable to identify early those subjects with HIF who are at high risk for IHM. This, to define conservative management, optimize quality of life and hospital resources.

Enfoque ortogeriátrico: manejo clínico perioperatorio de las fracturas de cadera en la persona mayor / Orthogeriatric approach: Perioperative clinical care of hip fractures in the elderly

Las fracturas de cadera (FC) son la complicación más grave de la fragilidad ósea. Presentan alta incidencia en el adulto mayor (AM), constituyéndose un problema de salud pública. Actualmente los objetivos del tratamiento son el retorno del paciente a su nivel funcional lo más pronto posible, reducción de la morbimortalidad y optimización de los recursos. Para ello es importante un abordaje multidisciplinario, una cirugía precoz (< 48 horas), así como una rehabilitación temprana. En la etapa aguda, el papel del geriatra incluye la evaluación clínica integral desde el ingreso a emergencia, la valoración y preparación prequirúrgica, prevención y manejo de complicaciones, así como la coordinación con los diversos recursos intrahospitalarios y extrahospitalarios.

Hip fracture is the most serious complication of bone fragility. Its incidence is high in the elderly and it constitutes a public health problem. Present treatment objectives are to return the patient to their previous level of functioning as soon as possible, to reduce the morbidity and mortality and to optimize resources. Hence a multi-disciplinary approach with prompt surgery (<48 hours) and early initiation of rehabilitation are important. In the acute phase the geriatrician does a comprehensive evaluation of the patient on admission to the Accident and Emergency Department and is responsible for pre-surgical preparation and evaluation, prevention and care of complications and coordination of the various resources inside and outside the hospital.

Complicaciones intrahospitalarias en ancianos con fractura de cadera: estudio transversal para determinar los factores asociados / In-hospital complications in elderly patients with hip fracture: cross-sectional study to determine the associated factors

Introducción El objetivo del trabajo es determinar cuáles son los factores asociados a la presencia de complicaciones intrahospitalarias en pacientes ancianos con fractura de cadera. Materiales & métodos Estudio retrospectivo, observacional de los pacientes mayores de 65 años ingresados al Hospital Universitario San Ignacio con fractura de cadera en el periodo comprendido entre enero de 2013 y diciembre de 2015. Se realizó la revisión de la historia clínica de cada paciente extrayendo datos demográficos, antecedentes patológicos, síndromes geriátricos, estado de ingreso, datos del procedimiento quirúrgico y la presencia de complicaciones. Posteriormente se procedió a realizar un análisis multivariado para determinar los factores asociados a la presencia de complicaciones intrahospitalarias. Resultados Durante el periodo de recolección se analizaron los datos de 141 pacientes, la edad promedio fue de 80.3 años (DE 7.86), el 62.4% de la muestra eran mujeres y el tiempo de estancia promedio fue de 7.89 días (DE 5.65). Las tres condiciones geriátricas más frecuentes fueron desnutrición, polifarmacia y caídas. El 53% de los pacientes eran independientes para la realización de actividades básicas de la vida diaria (Barthel > 90). Durante el tiempo de estancia hospitalaria el 54.6% de la muestra presentó alguna complicación. La mortalidad registrada en el periodo intrahospitalario fue de 9.9%. Discusión La dependencia funcional, el mayor riesgo anestésico, el requerimiento de oxígeno suplementario durante el postoperatorio y el tiempo de estancia hospitalaria fueron los principales factores independientes para la presencia de complicaciones intrahospitalarias.

Background This study aims to determine the factors associated with the presence of in-hospital complications in elderly patients with hip fracture. Methods A retrospective, observational study of patients older than 65 years admitted to the San Ignacio University Hospital (Bogotá, Colombia) with hip fracture in the period between January 2013 and December 2015. A review of the clinical history of each patient was carried out by extracting demographic data, disease history, geriatric syndromes, status on admission, date of the surgical procedure, and the presence of complications. A multivariate analysis was subsequently performed in order to determine the risk factors associated with the presence of in-hospital complications. Results An analysis was carried out on the data collected from 141 patients. The mean age was 80.3 years (SD 7.86), with 62.4% of the sample being women, and the mean hospital stay was 7.89 days (SD 5.65). The three most frequent geriatric conditions were malnutrition, polypharmacy, and falls, Just over half (53%) of the patients were independent for basic activities of daily living (Barthel> 90). During the hospital stay, 54.6% of the sample had some complication. Mortality in the hospital period was 9.9%. Discussion Functional dependence, increased anaesthetic risk, supplementary oxygen requirement during the post-operative period, and length of hospital stay were independent factors for the presence of in-hospital complications.

Fracturas de cadera y calidad de vida: la ortogeriatría en el ojo del huracán / Hip fractures and quality of life: Orthogeriatrics in the eye of the hurricane

Se revisan algunas áreas de desarrollo de la Ortogeriatría que inciden sobre la calidad de vida tanto de los equipos de salud como de los pacientes. En particular, se aborda la clasificación de los Modelos de Atención en Ortogeriatría, la investigación en Ortogteriatría en hispanoamérica, la definición nosológica de las fracturas de cadera, y la estandarización de la atención ortogeriátrica bajo conceptos de calidad. Se desarrolla la importancia que tienen estos aspectos sobre la calidad de vida relacionada con salud, se señalan los elementos más importantes a desarrollar en el futuro y se sugieren algunas propuestas de investigación.

We review developing areas of orthogeriatrics which impact quality of life in both patients and health teams. We highlight orthogeriatric models of care, orthogeriatric research in Latin America, the nosological definition of hip fractures and the standardization of orthogeriatric treatment with regards to quality. We expand on the importance of these aspects on quality of life with relation to health, point out the most important aspects to be developed, and suggest some lines of research.

Inpatient cost for hip fracture patients managed with an orthogeriatric care model in Singapore

<p><b>INTRODUCTION</b>The estimated incidence of hip fractures worldwide was 1.26 million in 1990 and is expected to double to 2.6 million by 2025. The cost of care for hip fracture patients is a significant economic burden. This study aimed to look at the inpatient cost of hip fractures among elderly patients placed under a mature orthogeriatric co-managed system.</p><p><b>METHODS</b>This study was a retrospective analysis of 244 patients who were admitted to the Department of Orthopaedics of Tan Tock Seng Hospital, Singapore, in 2011 for hip fractures under a mature orthogeriatric hip fracture care path. Information regarding costs, surgical procedures performed and patient demographics was collected.</p><p><b>RESULTS</b>The mean cost of hospitalisation was SGD 13,313.81. The mean cost was significantly higher for the patients who were managed surgically than for the patients who were managed non-surgically (SGD 14,815.70 vs. SGD 9,011.38; p < 0.01). Regardless of whether surgery was performed, the presence of complications resulted in a higher average cost (SGD 2,689.99 more than if there were no complications; p = 0.011). Every additional day from admission to time of surgery resulted in an increased cost of SGD 575.89, and the difference between the average cost of surgery within 48 hours and that of surgery > 48 hours was SGD 2,716.63.</p><p><b>CONCLUSION</b>Reducing the time to surgery and preventing pre- and postoperative complications can help reduce overall costs. A standardised care path that empowers allied health professionals can help to reduce perioperative complications, and a combined orthogeriatric care service can facilitate prompt surgical treatment.</p>

Modelos de atención en ortogeriatría: ¿qué tipo es éste o aquel? revisión y propuesta taxonómica / Models of care in orthogeriatrics: what type is this or that? systematic review and taxonomic proposal

Aunque la Ortogeriatría ha experimentado un explosivo desarrollo en los últimos 50 años, es difícil encontrar puntos de comparación entre los diferentes modelos de atención existentes. Se sabe relativamente poco acerca de cómo comparar entre sí los resultados obtenidos por unos y otros, y de cómo clasificarlos. Objetivo: Evaluar si es posible construir una propuesta taxonómica de los Modelos de Atención en Ortogeriatría (MAO) basada en la secuencia de momentos que conforman el curso clínico de la Fractura de Cadera (FC), la más importante patología ortogeriátrica. Diseño: Revisión sistemática. Método: Se revisó bases de datos electrónicas (Medline, NCBI (PubMed), TRIPy Google Scholar).Criterios de inclusión: Publicaciones en inglés o castellano, en revistas de impacto, entre enero 1990 y julio 2013, reportando intervenciones clínicas, exclusivamente de Ortogeriatría, de al menos 1 año de duración, sobre personas de 60 o más años con FC o para prevenir FC, explicitando el lugar donde se llevaron a cabo, el momento que abordaron en la evolución de la FC y concluyendo efectos beneficiosos. Resultados: 1044 coincidencias, 37 reportes seleccionados. Se identificó 4 tipos básicos de MAO, que sirvieron como base para construir una propuesta de clasificación. Conclusiones: La secuencia de momentos que conforman el curso clínico de la FC podría ser de utilidad para clasificar estos modelos. El sistema obtenido facilitaría la elección de uno u otro para implementar en diferentes situaciones, y homogenizaría la comparación de resultados de MAO similares...

Although orthogeriatrics have been explosively developed in last 50 years, is difficult to find points of comparison between different types of orthogeriatric care models (OCM). Relatively little is known about how to compare different outcomes between each other, and how to classify different OCM. Objectives: To develop a taxonomic proposal of OCM based on the sequence of moments in which each different OCM is implemented for managing hip fracture (HIF), the main orthogeriatric pathology. Methods: We reviewed electronic data bases (Medline, NCBI (PubMed), TRIP and Google Scholar) for OCM reports. We include studies reporting clinical experiences suggesting a specific orthogeriatric model centered in older people (60 or over) with HIF, explaining clearly the place where they were performed and the HIF evolutionary moment they approached. Results: After 1044 coincidences, 37 reports of 37 different OCM were selected. OCM were ordered following the care continuum criteria. Finally, 4 basic types of OCM were obtained, which served as the basis to develop a taxonomic proposal. Conclusions: The HIF clinical course was useful for generating a classification system for the different OCM. This taxonomic approach could help to take decisions to implement one or another kind of OCM in one or another situation, and to compare clinical indicators and outcomes between similar OCM...