Geriatric intervention in elderly patients with hip fracture in an orthopedic ward

Background: hip fracture is a common cause of long hospital stay in the elderly. approximately one third of these patients die within the first year. as a consequence geriatric and orthopedic collaboration (orthogeriatrics) has been organized in different ways. the aim of this study is to evaluate the efficiency of a multidisciplinary geriatric in-hospital intervention on patient outcome.methods: a total of 495 elderly hip fracture patients consecutively admitted to orthopedic surgery, were followed. data were based on medical records. the intervention group (n=233) was compared to a historical cohort group (n=262) receiving traditional orthopedic treatment. intervention program was based on initial physical and mental screening and evaluation, geriatric-focused care, and early discharge planning. the intervention was provided by a multidisciplinary geriatric team. after discharge, follow-up home-visits by a physiotherapist were performed, except for patients discharged to nursing homes, due to a 24-hour staff and easy access to the gp.results: median length of stay was reduced from 15 to 13 days. more patients began treatment with calcium/vitamin-d and bisphosphonate (p=sig). there was no difference in hemoglobin variation between the time of admission and three to six months post admission, and no difference in three-month readmissions (odds ratio (or) = 1.09 [95%ci: 0.71;1.67]). discharge destination was unchanged (or=0.93 [95%ci: 0.52; 1.65]). in-hospital mortality was 8% in the intervention group vs. 6% (p=0.48), in the control group. three-month mortality was 16% in the intervention group vs. 15% (p=0.39), in the control group. in the intervention group, residents from nursing homes had a higher three-month mortality (or=2.37 [95% ci: 0.99; 5.67]), and the risk of new fractures within two years decreased from 9.5% to 7.7%, though not statistically significant.conclusion: our study indicates that co-management of hip fracture patients by orthopedic surgeons and geriatricians may be associated with a reduction in length of hospital stay without negatively affecting major patient outcomes. the concept should be further developed particularly among the frail elderly