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老年骨科共管模式治疗髋部骨折老年患者:意大利多学会共识推荐。

Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus.

机构信息

Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, 00128, Rome, Italy.

Operative Unit of Anesthesia and Resuscitation, Hospital of Camposampiero, Padua, Italy.

出版信息

Aging Clin Exp Res. 2021 Sep;33(9):2405-2443. doi: 10.1007/s40520-021-01898-9. Epub 2021 Jul 21.


DOI:10.1007/s40520-021-01898-9
PMID:34287785
Abstract

BACKGROUND: Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM: To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS: A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS: A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION: These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.

摘要

背景:髋部骨折(HF)老年患者的健康结果可能会受到多种合并症和虚弱的负面影响。因此,强烈推荐采用综合多学科方法(即矫形老年医学模式),但由于缺乏共同管理方案和对该问题认识不足,其在临床实践中的实施受到阻碍。本共识文件的实施旨在解决这些问题。

目的:为髋部骨折老年患者的矫形科联合管理制定基于证据的推荐意见。

方法:成立了一个由 20 名老年病学家、矫形外科医生、麻醉师、物理治疗师和普通科医生组成的专家任务小组,以制定髋部骨折老年住院患者(≥65 岁)术前、围手术期、术中和术后护理的循证推荐意见。采用改良 Delphi 方法达成共识,并使用美国预防服务工作组系统对推荐意见的强度和证据质量进行评级。

结果:共提出了 120 条建议,涵盖 32 个临床主题,涉及术前评估(11 个主题)、围手术期(8 个主题)和术中(3 个主题)管理以及术后护理(10 个主题)。

结论:这些建议应通过整合不同专家的专业知识,简化和促进老年髋部骨折患者的多学科管理。通过提供一个感兴趣的主题列表,它们可以帮助确定未满足的需求和研究重点。

相似文献

[1]
Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus.

Aging Clin Exp Res. 2021-9

[2]
Management of hip fracture in the older people: rationale and design of the Italian consensus on the orthogeriatric co-management.

Aging Clin Exp Res. 2020-5-1

[3]
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Aging Clin Exp Res. 2022-7

[4]
Perioperative Management of Elderly patients (PriME): recommendations from an Italian intersociety consensus.

Aging Clin Exp Res. 2020-7-10

[5]
Identifying a standard set of outcome parameters for the evaluation of orthogeriatric co-management for hip fractures.

Injury. 2013-7-21

[6]
The consistency of care for older patients with a hip fracture: are the results of the integrated orthogeriatric treatment model of the Centre of Geriatric Traumatology consistent 10 years after implementation?

Arch Osteoporos. 2018-11-19

[7]
Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models.

Age Ageing. 2017-5-1

[8]
Orthogeriatric care for the elderly with hip fractures: where are we?

Aging Clin Exp Res. 2008-4

[9]
Orthogeriatrics in the management of frail older patients with a fragility fracture.

Osteoporos Int. 2015-10

[10]
Orthogeriatric co-management improves the outcome of long-term care residents with fragility fractures.

Arch Orthop Trauma Surg. 2016-10

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BMC Geriatr. 2025-3-1

[2]
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Support Care Cancer. 2025-2-1

[3]
Predictors of non-adherence to an early in-hospital rehabilitation program after surgery for hip fracture in a co-managed orthogeriatric unit.

Aging Clin Exp Res. 2024-10-12

[4]
Implementation status of postoperative rehabilitation for older patients with hip fracture in Kyoto City, Japan: A population-based study using medical and long-term care insurance claims data.

PLoS One. 2024

[5]
Management of geriatric acetabular fractures: Contemporary treatment strategies.

World J Clin Cases. 2024-5-6

[6]
Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach.

BMC Prim Care. 2024-4-19

[7]
Risk prediction of second hip fracture by bone and muscle density of the hip varies with time after first hip fracture: A prospective cohort study.

Bone Rep. 2023-12-22

[8]
Effects of rehabilitation therapy based on exercise prescription on motor function and complications after hip fracture surgery in elderly patients.

BMC Musculoskelet Disord. 2023-10-14

[9]
Severely injured patients: modern management strategies.

EFORT Open Rev. 2023-5-9

[10]
Rehabilitation after Hip Fracture Surgery: A Survey on Italian Physiotherapists' Knowledge and Adherence to Evidence-Based Practice.

Healthcare (Basel). 2023-3-8

本文引用的文献

[1]
The incidence of severe urinary tract infection increases after hip fracture in the elderly: a nationwide cohort study.

Sci Rep. 2021-2-9

[2]
Effect of oral anticoagulant use on surgical delay and mortality in hip fracture.

Bone Joint J. 2021-2

[3]
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BJA Educ. 2020-5

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Anemia at Presentation Predicts Acute Mortality and Need for Readmission Following Geriatric Hip Fracture.

JB JS Open Access. 2020-9-28

[5]
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Drugs Aging. 2021-1

[6]
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Bone Joint Res. 2020-9-3

[7]
Impact of direct oral anticoagulant therapy on operative delay, blood loss, transfusion and postoperative morbidity mortality in hip fracture patient, an observational study.

Thromb Res. 2020-10

[8]
Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study.

Sci Rep. 2020-6-15

[9]
Pneumonia in hospitalized elderly hip fracture patients: the effects on length of hospital-stay, in-hospital and thirty-day mortality and a search for potential predictors.

Injury. 2020-8

[10]
Effect of postoperative continuation of antibiotic prophylaxis on the incidence of surgical site infection: a systematic review and meta-analysis.

Lancet Infect Dis. 2020-5-26

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