Department of Trauma and Orthopaedic Surgery, Klinikum Nuernberg, Breslauer Str. 201, 90471, Nuremberg, Germany,
Arch Orthop Trauma Surg. 2013 Nov;133(11):1527-31. doi: 10.1007/s00402-013-1845-z. Epub 2013 Sep 1.
To evaluate changes in hospital length-of-stay and time-to-operation of older hip fracture patients before and after the foundation of a co-managed Geriatric Fracture Center (GFC).
A co-managed GFC was established in a German level-1 trauma center. In a retrospective cohort study, we analyzed femoral neck fracture patients >60 years treated with hemiarthroplasty. Patients treated within the first year after foundation of the GFC were compared to the patients treated during the year before. One-way ANOVA was performed to identify differences regarding time-to-operation and hospital length-of-stay.
One hundred and fourteen patients of the GFC were compared to 169 patients previously treated without co-management. Mean patient age did not significantly differ (81.9 vs. 81.5 years; p = 0.7), nor did gender distribution. Hospital length-of-stay was significantly shorter after foundation of the GFC (13.9 vs. 16.8 days; p = 0.007). The same is true for the interval between hospital admission and operation, which decreased from 3.1 to 2.1 days (p = 0.029). Early surgical complication rate was not significantly affected by GFC foundation (7.7 % pre-GFC vs. 9.6 % GFC; p = 0.6), nor was inpatient mortality (5.9 % pre-GFC vs. 4.4 % GFC; p = 0.6). Subgroup analysis revealed that GFC patients without early surgical complications displayed a reduced length-of-stay (LOS), whereas LOS was even prolonged in GFC patients with surgical complications.
A co-managed GFC offering an organized fracture program for the elderly can reduce hospital length-of-stay and time-to-operation in hip fracture patients. A significant effect can be observed within the first year after establishment of a GFC.
评估老年髋部骨折患者在共管老年骨折中心（GFC）成立前后的住院时间和手术时间的变化。
在德国一级创伤中心建立了共管 GFC。在一项回顾性队列研究中，我们分析了接受人工股骨头置换术治疗的>60 岁股骨颈骨折患者。将 GFC 成立后第一年接受治疗的患者与前一年接受治疗的患者进行比较。采用单因素方差分析比较手术时间和住院时间的差异。
114 名 GFC 患者与 169 名未接受共管治疗的患者进行了比较。患者年龄无显著差异（81.9 岁比 81.5 岁；p=0.7），性别分布也无差异。GFC 成立后住院时间明显缩短（13.9 天比 16.8 天；p=0.007）。从入院到手术的间隔时间也从 3.1 天缩短至 2.1 天（p=0.029），这同样是 GFC 成立的结果。GFC 成立并未显著影响早期手术并发症发生率（GFC 前为 7.7%，GFC 为 9.6%；p=0.6），住院死亡率也无差异（GFC 前为 5.9%，GFC 为 4.4%；p=0.6）。亚组分析显示，无早期手术并发症的 GFC 患者的住院时间缩短（LOS），而 GFC 有手术并发症的患者的 LOS 甚至延长。
管理老年骨折患者的共管 GFC 可缩短髋部骨折患者的住院时间和手术时间。在 GFC 成立后的第一年可以观察到显著的效果。
