Eficacia de la asistencia compartida entre cirujanos e internistas para ancianos con fractura de cadera / Effectiveness of co-management between orthopaedic surgeons and internists for inpatient elders with hip fracture

Fundamento y objetivo: La fractura de cadera es una lesión frecuente en ancianos con comorbilidades, lo que aumenta los riesgos de morbimortalidad, que podrían reducirse con asistencia compartida (AC) entre cirujanos ortopédicos e internistas. El objetivo de este trabajo fue evaluar la eficacia de esta AC. Pacientes y método: Estudio prospectivo de 138 pacientes mayores de 64 años con fractura de cadera tratados con AC y seguimiento de un año. Se comparó con una cohorte de 153 pacientes tratados con asistencia convencional y similares criterios de inclusión. Se analizaron diversas variables prequirúrgicas y posquirúrgicas, complicaciones, y factores de riesgo potenciales de mortalidad. Se utilizaron el índice de Charlson, un test mental, el de calidad de vida de Katz y el SF-12, y para la función de cadera, la escala de Merle D’Aubigné. Resultados: La demora quirúrgica fue menor en la cohorte AC (p = 0,001). Las tasas de complicaciones y reingresos fueron similares en ambas cohortes. La estancia media fue menor (p = 0,001) en la cohorte AC. La mortalidad intrahospitalaria y a 3 meses fueron similares, pero era menor en la cohorte AC a los 6 (p = 0,04) y 12 meses (p = 0,03). En ambas cohortes no fueron predictores de mortalidad el sexo, el número de comorbilidades, la puntuación ASA, el índice de Charlson ni el tipo de cirugía. En la cohorte AC era predictora la demora quirúrgica > 2 días, mientras que en la cohorte convencional lo era la edad. Los resultados funcionales finales fueron similares en ambas cohortes. Conclusión: Nuestros resultados muestran la efectividad de la AC para reducir la demora quirúrgica, la estancia y la mortalidad a partir de 6 meses (AU)

Background and objective: Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM. Patients and method: Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D’Aubigne' hip score were used. Results: Surgical delay was lower in the CM cohort (P = .001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P = .001) in the CM cohort. In hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P = .04) and 12 months (P = .03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay > 2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts. Conclusion: Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months (AU)

[Effectiveness of co-management between orthopaedic surgeons and internists for inpatient elders with hip fracture]. / Eficacia de la asistencia compartida entre cirujanos e internistas para ancianos con fractura de cadera.

BACKGROUND AND OBJECTIVE: Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM. PATIENTS AND METHOD: Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used. RESULTS: Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts. CONCLUSION: Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months.