老年骨科共管与髋部骨折后死亡率的关系。
The Association Between Orthogeriatric Co-Management and Mortality Following Hip Fracture.
机构信息
Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart; School of Health Sciences, University of Manchester, and Manchester Academic Health Sciences Centre, and Manchester University NHS Foundation Trust, Manchester, UK; Institute of Epidemiology and Medical Biom etry, Ulm University, Ulm; Center for Trauma Research, Ulm University, Ulm; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Orthopedics and Trauma Surgery, Marienhospital, Stuttgart; Department of Orthopedics and Trauma Surgery, Diakonissen Hospital Karlsruhe-Rüppurr, Karlsruhe.
出版信息
Dtsch Arztebl Int. 2020 Jan 24;117(4):53-59. doi: 10.3238/arztebl.2020.0053.
BACKGROUND
To meet the special needs of older patients with fragility fractures, models for collaborative orthogeriatric care have been developed. The objective of our study was to analyze the association of orthogeriatric co-management with mortality following hip fracture in older patients in Germany.
METHODS
This observational study was based on health insurance claims data from 58 001 patients (79.4% women) aged ≥80 years admitted to the hospital with hip fracture between January 2014 and March 2016. They were treated in 828 German hospitals with or without orthogeriatric co-management. The outcome measure was cumulative mortality with adjustment of the regression analyses.
RESULTS
The crude 30-day mortality was 10.3% for patients from hospitals with orthogeriatric co-management and 13.4% for patients from hospitals without orthogeriatric co-management. The adjusted 30-day mortality was 22% lower for patients in hospitals with orthogeriatric co-management (rate ratio 0.78; 95% CI [0.74; 0.82]; adjusted absolute difference -2.48%; 95% CI [-2.98; -1.98]). The difference in 30-day mortality remained nearly unchanged over the first 6 months. The risk reduction with orthogeriatric co-management was consistently observed in both women and men, across age groups, and in patients with and without care needs. The mean length of the index stay was 19.8 days in hospitals with orthogeriatric co-management and 14.4 days in hospitals without orthogeriatric co-management.
CONCLUSION
A multidisciplinary orthogeriatric approach is associated with lower mortality and a longer index stay in hospital after hip fracture.
背景
为满足脆弱性骨折老年患者的特殊需求，已开发出协作式骨科老年病学护理模式。我们的研究目的是分析德国老年髋部骨折患者接受骨科老年病学共同管理与死亡率的相关性。
方法
本观察性研究基于 2014 年 1 月至 2016 年 3 月期间因髋部骨折住院的 58001 名（79.4%为女性）年龄≥80 岁患者的医疗保险索赔数据。这些患者在 828 家德国医院接受治疗，其中部分医院实施了骨科老年病学共同管理，部分未实施。结局指标为调整回归分析后的累积死亡率。
结果
实施骨科老年病学共同管理的医院患者的 30 天粗死亡率为 10.3%，未实施骨科老年病学共同管理的医院患者的 30 天粗死亡率为 13.4%。实施骨科老年病学共同管理的医院患者的 30 天调整死亡率低 22%（调整率比 0.78；95%CI [0.74；0.82]；调整后绝对差异 -2.48%；95%CI [-2.98%；-1.98%]）。在最初 6 个月内，30 天死亡率的差异几乎保持不变。在女性和男性、各年龄段以及有和无护理需求的患者中，均观察到骨科老年病学共同管理可降低风险。实施骨科老年病学共同管理的医院患者的指数住院时间平均为 19.8 天，未实施骨科老年病学共同管理的医院患者的指数住院时间平均为 14.4 天。
结论
多学科骨科老年病学方法与髋部骨折后较低的死亡率和更长的指数住院时间相关。
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