TY - JOUR
T1 - Improved Survival of Hip Fracture Patients Treated Within a Comprehensive Geriatric Hip Fracture Unit, Compared With Standard of Care Treatment
AU - Adunsky, Abraham
AU - Lerner-Geva, Liat
AU - Blumstein, Tzvia
AU - Boyko, Valentina
AU - Mizrahi, Eliyahu
AU - Arad, Marina
PY - 2011/7
Y1 - 2011/7
N2 - Objectives: To compare survival rates of hip fracture patients treated within a comprehensive geriatric hip fracture unit (CGHFU) with those undergoing a standard of care treatment (SOCT) in general orthopedic wards. Design: Retrospective chart review. Setting: A geriatric hip fracture unit of a division of geriatric medicine and rehabilitation and departments of general orthopedic surgery of a tertiary hospital. Participants: Participants were 3114 consecutive hip fracture patients: 847 were admitted to CGHFU and 2267 to wards of general orthopedics. Intervention: Surgical repair followed by standard rehabilitation course. Measurement: Mortality rates at 30 days, 90 days, and 1 year. Results: CGHFU population was older (P < .0001), comprised more women (P < .0001), and suffered a greater number of comorbidities (P < .0001). Crude 30-day mortality rates were 1.9% and 3.0% for CGHFU and SOCT, respectively. At 90 days, crude rates were 6.5% and 8.1%, respectively, and 14.8% and 17.3%, at 1 year, respectively. Cox proportional hazard models adjusted for sociodemographics, Comorbidity, and surgery characteristics showed borderline significant lower mortality hazard ratios for CGHFU in comparison with SOCT, for 1-month and 3-month intervals. The adjusted Cox model favored the CGHFU modality of care with regard to 1-year cumulative mortality (hazard ratios 0.78, 95% confidence interval 0.63-0.96, P = .016). Male gender, age, diabetes, and number of operations were predictive of increased 1-year mortality risk in the separate regression models by gender and age group (<85, 85+). Conclusion: Crude and adjusted mortality rates are lower in a geriatric hip fracture unit, as compared with the common standard of care model of general orthopedic wards. Combined with earlier data on improved functional outcomes of CGHFU, these findings further support the implementation of similar comprehensive orthogeriatric models of care.
AB - Objectives: To compare survival rates of hip fracture patients treated within a comprehensive geriatric hip fracture unit (CGHFU) with those undergoing a standard of care treatment (SOCT) in general orthopedic wards. Design: Retrospective chart review. Setting: A geriatric hip fracture unit of a division of geriatric medicine and rehabilitation and departments of general orthopedic surgery of a tertiary hospital. Participants: Participants were 3114 consecutive hip fracture patients: 847 were admitted to CGHFU and 2267 to wards of general orthopedics. Intervention: Surgical repair followed by standard rehabilitation course. Measurement: Mortality rates at 30 days, 90 days, and 1 year. Results: CGHFU population was older (P < .0001), comprised more women (P < .0001), and suffered a greater number of comorbidities (P < .0001). Crude 30-day mortality rates were 1.9% and 3.0% for CGHFU and SOCT, respectively. At 90 days, crude rates were 6.5% and 8.1%, respectively, and 14.8% and 17.3%, at 1 year, respectively. Cox proportional hazard models adjusted for sociodemographics, Comorbidity, and surgery characteristics showed borderline significant lower mortality hazard ratios for CGHFU in comparison with SOCT, for 1-month and 3-month intervals. The adjusted Cox model favored the CGHFU modality of care with regard to 1-year cumulative mortality (hazard ratios 0.78, 95% confidence interval 0.63-0.96, P = .016). Male gender, age, diabetes, and number of operations were predictive of increased 1-year mortality risk in the separate regression models by gender and age group (<85, 85+). Conclusion: Crude and adjusted mortality rates are lower in a geriatric hip fracture unit, as compared with the common standard of care model of general orthopedic wards. Combined with earlier data on improved functional outcomes of CGHFU, these findings further support the implementation of similar comprehensive orthogeriatric models of care.
KW - Hip fracture
KW - Mortality
KW - Orthogeriatric care
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=79959623269&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2010.09.003
DO - 10.1016/j.jamda.2010.09.003
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AN - SCOPUS:79959623269
SN - 1525-8610
VL - 12
SP - 439
EP - 444
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 6
ER -
