Unidad de Ortogeriatría, Hospital Universitario de Salamanca, Salamanca, Spain.
Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain.
Orthop Surg. 2020 Apr;12(2):457-462. doi: 10.1111/os.12633. Epub 2020 Mar 13.
To investigate the clinical efficacy of three different healthcare models (Traditional Model, Geriatric Consultant Model, and Orthogeriatric Unit Model) consecutively applied to a single academic center (University Hospital of Salamanca, Spain) for older hip fracture patients.
We performed a retrospective study, including 2741 hip fracture patients older than 64 years, admitted between 1 January 2003 and 31 December 2014 to the University Hospital of Salamanca. Patients were divided into three groups according to the healthcare model applied. There were 983 patients on the Traditional Model, 945 patients on the Geriatric Consultant Model, and 813 patients on the Orthogeriatric Unit Model. We recorded age and gender of patients, functional status at admission (Barthel Index, Katz Index, and Physical Red Cross Scale), type of fracture, and intervention, and we analyzed the length of stay, time to surgery, post-surgical stay, and in-hospital mortality according to the healthcare model applied.
Hip fractures are much more frequent in women, and an increase in the average age of patients was observed along with the study (P < 0.001). The most common type of fracture in the three models studied was an extracapsular fracture, for which the most common surgical procedure used was osteosynthesis. On the functional status of patients, there were no differences on the ambulatory ability previous to fracture, measured by the Physical Red Cross Scale, and the percentage of patients with a slight dependence determined by the Barthel Index (>60) was similar in both groups, but considering the Katz Index, the percentage of patients with a high degree of independence (A-B) was significantly higher for the group of patients treated on the Orthogeriatric Unit Model period (56%, P = 0.009). The Orthogeriatric Unit Model registered the greatest percentage of patients undergoing surgery (96.1%, P < 0.001) and the greatest number of early surgical procedures (<24 h) (24.8%, P < 0.001). The orthogeriatric unit model showed the shortest duration of stay (9 days median), decreasing by one day in respect of each of the other models studied (P < 0.001). Time to surgery was also significantly reduced with the Orthogeriatric Unit Model (median of 3 days, P < 0.001). With regard to in-hospital follow-up, there was a reduction in in-hospital mortality during the study period. We observed differences among the three healthcare models, but without statistical significance.
The healthcare model based on an Orthogeriatric Unit seems to be the most efficient, because it reaches a reduction in time to surgery, with an increased number of patients surgically treated on in the first 24 h, and the greatest frequency of surgically-treated patients.
连续在单一学术中心（西班牙萨拉曼卡大学医院）应用三种不同的医疗保健模式（传统模式、老年病顾问模式和矫形外科-老年病学单元模式），以调查其对老年髋部骨折患者的临床疗效。
我们进行了一项回顾性研究，纳入了 2003 年 1 月 1 日至 2014 年 12 月 31 日期间入住萨拉曼卡大学医院的 2741 例年龄超过 64 岁的髋部骨折患者。根据应用的医疗保健模式将患者分为三组。传统模式组有 983 例患者，老年病顾问模式组有 945 例患者，矫形外科-老年病学单元模式组有 813 例患者。我们记录了患者的年龄和性别、入院时的功能状态（巴氏指数、卡茨指数和物理红十字量表）、骨折类型和干预措施，并根据应用的医疗保健模式分析了住院时间、手术时间、术后住院时间和院内死亡率。
女性髋部骨折更为常见，随着研究的进行，患者的平均年龄也有所增加（P<0.001）。三种模式中最常见的骨折类型是囊外骨折，最常见的手术方法是骨合成。在患者的功能状态方面，三组患者在骨折前的步行能力（物理红十字量表）上没有差异，使用巴氏指数（>60 分）确定的轻度依赖患者比例相似，但考虑到卡茨指数，接受矫形外科-老年病学单元模式治疗的患者中高度独立（A-B）的比例显著更高（56%，P=0.009）。矫形外科-老年病学单元模式组的手术比例最高（96.1%，P<0.001），且<24 小时内进行早期手术的患者比例也最高（24.8%，P<0.001）。矫形外科-老年病学单元模式组的住院时间最短（中位数为 9 天），比其他两种研究模式均减少了一天（P<0.001）。手术时间也随着矫形外科-老年病学单元模式的应用而显著缩短（中位数为 3 天，P<0.001）。关于院内随访，研究期间院内死亡率有所下降。我们观察到三种医疗保健模式之间存在差异，但无统计学意义。
基于矫形外科-老年病学单元的医疗保健模式似乎最有效，因为它可以缩短手术时间，增加在 24 小时内接受手术治疗的患者数量，并提高手术治疗患者的比例。
