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