Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.
Osteoporos Int. 2021 Nov;32(11):2225-2233. doi: 10.1007/s00198-021-05974-8. Epub 2021 May 8.
Hip fracture patients often display an acute confusional state (delirium) which is associated with worse outcomes. In this observational study, we found that co-management of hip fracture patients by a multidisciplinary team including a geriatrician and an orthopaedic surgeon could reduce the incidence of delirium.
Delirium after hip fracture is common and is associated with negative outcomes. We investigated if orthogeriatric co-management reduced the incidence of delirium in hip fracture patients.
In this single-centre, prospective observational study, we compared the incidence of delirium and subsyndromal delirium (SSD) before (usual care group, n = 94) and after (orthogeriatric group, n = 103) the introduction of orthogeriatric co-management as an integrated care model. The outcome measure 'no delirium/SSD/delirium' was treated as an ordinal variable and analysed using the chi-squared test and multivariable ordinal logistic regression.
The groups had similar baseline characteristics except for a higher proportion of patients with pre-existing cognitive impairment in the usual care group (51% vs. 37%, p = 0.045). Fewer patients in the orthogeriatric group developed SSD or delirium (no delirium: 59% vs. 40%/SSD: 6% vs. 13%/delirium: 35% vs. 47%; p = 0.021). The number needed to treat (NNT) to avoid one case of SSD or delirium was 5.3 (95% CI: 3.1 to 19.7). In a multivariable analysis adjusted for age, sex, ASA class, pre-existing cognitive impairment, time to surgery, type of surgery, and medical or surgical complications, the odds ratio for the development of SSD/delirium was lower in the orthogeriatric group (OR = 0.46, 95% CI: 0.23-0.89, p = 0.023).
Orthogeriatric co-management as an integrated care model reduced the incidence of SSD/delirium in hip fracture patients.
髋部骨折患者常出现急性意识混乱（谵妄），这与预后较差有关。在这项观察性研究中，我们发现多学科团队（包括老年病学家和骨科医生）共同管理髋部骨折患者可以降低谵妄的发生率。
髋部骨折后谵妄很常见，与不良结局相关。我们研究了骨科老年病学联合管理是否可以降低髋部骨折患者谵妄的发生率。
在这项单中心前瞻性观察性研究中，我们比较了引入骨科老年病学联合管理（作为一种综合护理模式）前后（常规护理组，n=94；骨科老年病学组，n=103）谵妄和亚综合征性谵妄（SSD）的发生率。将“无谵妄/SSD/谵妄”的结果作为有序变量进行分析，采用卡方检验和多变量有序逻辑回归进行分析。
两组患者的基线特征相似，但常规护理组患者中存在预先存在的认知障碍的比例较高（51%比37%，p=0.045）。骨科老年病学组发生 SSD 或谵妄的患者较少（无谵妄：59%比40%/SSD：6%比 13%/谵妄：35%比 47%；p=0.021）。为避免一例 SSD 或谵妄，需要治疗的患者数（NNT）为 5.3（95%CI：3.1 至 19.7）。在调整年龄、性别、ASA 分级、预先存在的认知障碍、手术时间、手术类型以及医疗或手术并发症后，多变量分析显示骨科老年病学组发生 SSD/谵妄的比值比（OR）较低（OR=0.46，95%CI：0.23 至 0.89，p=0.023）。
骨科老年病学联合管理作为一种综合护理模式降低了髋部骨折患者 SSD/谵妄的发生率。
