Fisher A A, Davis M W, Rubenach S E, Sivakumaran S, Smith P N, Budge M M
Department of Geriatric Medicine, ACT, Australia.
J Orthop Trauma. 2006 Mar;20(3):172-8; discussion 179-80. doi: 10.1097/01.bot.0000202220.88855.16.
To assess the impact of a specifically designed model of orthopedic-geriatric cocare on hip fracture (HF) outcomes.
Tertiary teaching hospital (level I trauma center).
Prospective observational study with a retrospective (historical) control. Data on 951 consecutive patients 60 years of age or older admitted to the authors' institution with a nonpathologic HF over a 7-year period (1995 to 2002) were analyzed. Between 1995 and 1997, medical problems were managed by a geriatric medicine (GM) consultation-only service (retrospective audit). In 1998, a GM registrar began overseeing daily medical care with weekly geriatrician consultant review (prospective study). Outcomes for 2 time periods were compared: a 3-year period before (no GM; 504 patients) and a 4-year period after (GM; 447 patients) the introduction of GM cocare.
Postoperative medical complications, mortality, length of stay, discharge destination, use of thromboprophylaxis, and antiosteoporotic treatment.
While comparing 2 periods (GM and no GM), significant reductions in postoperative medical complications and comorbid conditions (in total 49.5% vs. 71.0%, P<0.001) and mortality (4.7% vs. 7.7%, P<0.01) occurred and rehospitalization to medical wards within 6 months decreased (28% vs. 7.6%). However, no differences were observed in median length of hospital stay (10.8 vs. 11.0 days) or in discharge destination. Antiosteoporotic treatment (12% to 69%) and specific thromboprophylaxis (63% to 94%) increased in the GM period.
Orthopedic-geriatric cocare for the older patients with HF was associated with significant reductions in morbidity and mortality, and increases in optimal postoperative care. Options for further improvement of orthopedic-GM cocare need to be investigated.
评估专门设计的骨科 - 老年共护模式对髋部骨折（HF）治疗结果的影响。
三级教学医院（一级创伤中心）。
一项采用回顾性（历史性）对照的前瞻性观察研究。分析了作者所在机构在7年期间（1995年至2002年）收治的951例60岁及以上非病理性髋部骨折连续患者的数据。1995年至1997年期间，医疗问题由仅提供老年医学（GM）会诊的服务进行管理（回顾性审核）。1998年，一名GM住院医师开始监督日常医疗护理，每周由老年医学顾问进行复查（前瞻性研究）。比较了两个时间段的结果：引入GM共护之前的3年期间（无GM；504例患者）和之后的4年期间（有GM；447例患者）。
术后医疗并发症、死亡率、住院时间、出院去向、血栓预防措施的使用以及抗骨质疏松治疗。
在比较两个时期（有GM和无GM）时，术后医疗并发症和合并症显著减少（分别为49.5%对71.0%，P<0.001），死亡率降低（4.7%对7.7%，P<0.01），6个月内再次入住内科病房的情况减少（28%对7.6%）。然而，中位住院时间（10.8天对11.0天）或出院去向没有差异。在GM时期，抗骨质疏松治疗（从12%增至69%）和特定血栓预防措施（从63%增至94%）有所增加。
老年髋部骨折患者的骨科 - 老年共护与发病率和死亡率的显著降低以及术后最佳护理的增加相关。需要研究进一步改善骨科 - GM共护的方法。
