Folbert E C, Hegeman J H, Vermeer M, Regtuijt E M, van der Velde D, Ten Duis H J, Slaets J P
Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands.
ZGT Academy, Ziekenhuisgroep Twente, Almelo/Hengelo, The Netherlands.
Osteoporos Int. 2017 Jan;28(1):269-277. doi: 10.1007/s00198-016-3711-7. Epub 2016 Jul 21.
To improve the quality of care and reduce the healthcare costs of elderly patients with a hip fracture, surgeons and geriatricians collaborated intensively due to the special needs of these patients. After treatment at the Centre for Geriatric Traumatology (CvGT), we found a significant decrease in the 1-year mortality rate in frail elderly patients compared to the historical control patients who were treated with standard care.
The study aimed to evaluate the effect of an orthogeriatric treatment model on elderly patients with a hip fracture on the 1-year mortality rate and identify associated risk factors.
This study included patients, aged 70 years and older, who were admitted with a hip fracture and treated in accordance with the integrated orthogeriatric treatment model of the CvGT at the Hospital Group Twente (ZGT) between April 2008 and October 2013. Data registration was carried out by several disciplines using the clinical pathways of the CvGT database. A multivariate logistic regression analysis was used to identify independent risk factors for 1-year mortality. The outcome measures for the 850 patients were compared with those of 535 historical control patients who were managed under standard care between October 2002 and March 2008.
The analysis demonstrated that the 1-year mortality rate was 23.2 % (n = 197) in the CvGT group compared to 35.1 % (n = 188) in the historical control group (p < 0.001). Independent risk factors for 1-year mortality were male gender (odds ratio (OR) 1.68), increasing age (OR 1.06), higher American Society of Anesthesiologists (ASA) score (ASA 3 OR 2.43, ASA 4-5 OR 7.05), higher Charlson Comorbidity Index (CCI) (CCI 1-2 OR 1.46, CCI 3-4 OR 1.59, CCI 5 OR 2.71), malnutrition (OR 2.01), physical limitations in activities of daily living (OR 2.35), and decreasing Barthel Index (BI) (OR 0.96).
After integrated orthogeriatric treatment, a significant decrease was seen in the 1-year mortality rate in the frail elderly patients with a hip fracture compared to the historical control patients who were treated with standard care. The most important risk factors for 1-year mortality were male gender, increasing age, malnutrition, physical limitations, increasing BI, and medical conditions. Awareness of risk factors that affect the 1-year mortality can be useful in optimizing care and outcomes. Orthogeriatric treatment should be standard for elderly patients with hip fractures due to the multidimensional needs of these patients.
为提高髋部骨折老年患者的护理质量并降低医疗成本，鉴于这些患者的特殊需求，外科医生和老年病科医生进行了密切合作。在老年创伤中心（CvGT）接受治疗后，我们发现与接受标准护理的历史对照患者相比，体弱老年患者的1年死亡率显著降低。
本研究旨在评估骨科 - 老年病综合治疗模式对髋部骨折老年患者1年死亡率的影响，并确定相关危险因素。
本研究纳入了年龄在70岁及以上、因髋部骨折入院并于2008年4月至2013年10月期间在特温特医院集团（ZGT）按照CvGT的综合骨科 - 老年病治疗模式进行治疗的患者。数据由多个学科使用CvGT数据库的临床路径进行登记。采用多因素逻辑回归分析来确定1年死亡率的独立危险因素。将850例患者的结局指标与2002年10月至2008年3月期间接受标准护理的535例历史对照患者的结局指标进行比较。
分析表明，CvGT组的1年死亡率为23.2%（n = 197），而历史对照组为35.1%（n = 188）（p < 0.001）。1年死亡率的独立危险因素包括男性（比值比（OR）1.68）、年龄增加（OR 1.06）、美国麻醉医师协会（ASA）评分较高（ASA 3级OR 2.43，ASA 4 - 5级OR 7.05）、Charlson合并症指数（CCI）较高（CCI 1 - 2级OR 1.46，CCI 3 - 4级OR 1.59，CCI 5级OR 2.71）、营养不良（OR 2.01）、日常生活活动存在身体限制（OR 2.35）以及Barthel指数（BI）降低（OR 0.96）。
与接受标准护理的历史对照患者相比，髋部骨折体弱老年患者在接受综合骨科 - 老年病治疗后，1年死亡率显著降低。1年死亡率的最重要危险因素包括男性、年龄增加、营养不良、身体限制、BI增加以及医疗状况。了解影响1年死亡率的危险因素有助于优化护理和改善结局。鉴于这些患者的多维度需求，骨科 - 老年病治疗应为髋部骨折老年患者的标准治疗方法。
