Geriatrics and Internal Medicine, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Aging Clin Exp Res. 2020 Jul;32(7):1245-1253. doi: 10.1007/s40520-020-01488-1. Epub 2020 Feb 5.
Hip fractures (HF) are a major issue worldwide. We aimed at evaluating the practices in delivering care to patients with HF among several Italian Orthogeriatric centers.
The study took place from February 2016 to July 2018. Seven performance indicators (pre-surgical cognitive assessment, surgery performed ≤ 48 h from fracture, removal of urinary catheter/absence of delirium/start of physiotherapy on the first post-operative day, prescription of bone protection at discharge, and discharge toward rehabilitation) were collected.
The 14 participating hospitals totally recruited 3.017 patients. Patients were old (median age 86 years; Inter Quartile Range [IQR] 80-90), mostly females (77%). Nearly 55% of them were already impaired in mobility and about 10% were nursing home residents. Median time-to-surgery was 41 h (IQR 23-62). Models of care greatly varied among centers, only 49.3% of patients being co-managed by geriatricians and orthopedics. There was high variability across centers in four indicators ("pre-surgical cognitive assessment", "bone protection prescription", "use of urinary catheter" and "start of physiotherapy"), moderate in two indicators ("surgery performed ≤ 48 h from fracture" and "discharge toward rehabilitation" and low in one ("absence of delirium on day following surgery"). Comparison with international studies suggests very different ways of providing care to HF Italian patients.
The study results suggest high inter-center variability in the key-performance indicators, and different approaches in providing care to our HF patients in comparison to other countries. A National debate on the topic is required in Italy to harmonize practices of orthogeriatric care.
髋部骨折（HF）是全球范围内的一个重大问题。我们旨在评估意大利几家矫形骨科中心在治疗 HF 患者方面的实践情况。
研究于 2016 年 2 月至 2018 年 7 月进行。收集了 7 项绩效指标（术前认知评估、骨折后 48 小时内进行手术、术后第一天拔除导尿管/无谵妄/开始物理治疗、出院时开具骨保护药物、以及出院后转至康复）。
参与的 14 家医院共招募了 3017 名患者。患者年龄较大（中位数年龄 86 岁；四分位距 [IQR] 80-90 岁），大多数为女性（77%）。近 55%的患者已经存在活动能力受损，约 10%的患者居住在养老院。手术时间中位数为 41 小时（IQR 23-62）。各中心的治疗模式差异很大，只有 49.3%的患者由老年病学家和骨科医生共同管理。在四个指标（“术前认知评估”、“骨保护药物处方”、“使用导尿管”和“开始物理治疗”）中，各中心之间存在高度变异性，在两个指标（“骨折后 48 小时内进行手术”和“出院后转至康复”）中存在中度变异性，在一个指标（“术后第一天无谵妄”）中存在低度变异性。与国际研究相比，这表明意大利 HF 患者的护理方式存在很大差异。
研究结果表明，关键绩效指标在各中心之间存在高度变异性，与其他国家相比，我们对 HF 患者的护理方式也存在差异。意大利需要就这一主题进行全国性辩论，以协调矫形骨科护理的实践。
