Friedman Susan M, Mendelson Daniel A, Bingham Karilee W, Kates Stephen L
Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14620, USA.
Arch Intern Med. 2009 Oct 12;169(18):1712-7. doi: 10.1001/archinternmed.2009.321.
Hip fractures are associated with substantial morbidity and mortality for older adults. Patients sustaining hip fractures usually have comorbid conditions that may benefit from comanagement by geriatricians and orthopedic surgeons.
The Geriatric Fracture Center (GFC) is part of a community teaching hospital. Patients are comanaged daily by a geriatrician and orthopedic surgeon, emphasizing total quality management, timely treatment, and standardized care. We reviewed medical records to compare process and outcome measures in the GFC with a local institution that did not have a fracture management service. Patients 60 years or older admitted for a proximal femur fracture from May 1, 2005, to April 30, 2006, were included; pathological, recurrent, high-energy, periprosthetic, and nonoperative fractures were excluded.
Geriatric Fracture Center patients (n = 193) were significantly older, were less likely to reside in the community, and had more comorbid conditions and dementia than usual care patients (n = 121). Despite baseline differences, GFC patients, compared with usual care patients, had shorter times to surgery (24.1 vs 37.4 hours), fewer postoperative infections (2.3% vs 19.8%), fewer complications overall (30.6% vs 46.3%), and shorter length of stay (4.6 vs 8.3 days). Compared with GFC patients, physical restraint use was significantly higher in usual care patients (0% vs 14.1%). After we adjusted for baseline characteristics, patients treated in the GFC had shorter times to surgery, shorter length of stay, fewer cardiac complications, and fewer cases of thromboembolism, delirium, and infection. There was no difference in in-hospital mortality or 30-day readmission rate.
Comanagement by geriatricians and orthopedic surgeons, combined with standardized care, leads to improved processes and outcomes for patients with hip fractures.
髋部骨折对于老年人来说会导致较高的发病率和死亡率。髋部骨折患者通常伴有多种合并症，可能受益于老年病科医生和骨科医生的共同管理。
老年骨折中心（GFC）是一家社区教学医院的一部分。患者由老年病科医生和骨科医生每日共同管理，强调全面质量管理、及时治疗和标准化护理。我们回顾了病历，以比较GFC与当地一家没有骨折管理服务机构的流程和结果指标。纳入了2005年5月1日至2006年4月30日期间因股骨近端骨折入院的60岁及以上患者；排除病理性、复发性、高能性、假体周围骨折和非手术骨折。
老年骨折中心的患者（n = 193）比常规护理患者（n = 121）年龄更大，居住在社区的可能性更小，合并症和痴呆症更多。尽管存在基线差异，但与常规护理患者相比，GFC患者的手术时间更短（24.1小时对37.4小时），术后感染更少（2.3%对19.8%），总体并发症更少（30.6%对46.3%），住院时间更短（4.6天对8.3天）。与GFC患者相比，常规护理患者使用身体约束的比例显著更高（0%对14.1%）。在对基线特征进行调整后，在GFC接受治疗的患者手术时间更短，住院时间更短，心脏并发症更少，血栓栓塞、谵妄和感染的病例也更少。住院死亡率或30天再入院率没有差异。
老年病科医生和骨科医生的共同管理，结合标准化护理，可改善髋部骨折患者的治疗流程和结果。
