Bub Christine, Stapleton Erik, Iturriaga Cesar, Garbarino Luke, Aziz Hadi, Wei Nicole, Mota Frank, Goldin Mark Eliot, Sinvani Liron Danay, Carney Maria Torroella, Goldman Ariel
Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY.
Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Plainview Hospital, Plainview, NY.
J Orthop Trauma. 2022 Apr 1;36(4):213-217. doi: 10.1097/BOT.0000000000002258.
To evaluate whether the implementation of a geriatrics-focused orthopaedic and hospitalist comanagement program can improve perioperative outcomes and decrease resource utilization.
A retrospective chart review study was conducted before and after the implementation of a geriatrics-focused orthopaedic and hospitalist comanagement program, based on the American Geriatrics Society (AGS) AGS CoCare:Ortho.
A large urban, academic tertiary center, located in the greater New York metropolitan area.
Patients 65 years and older hospitalized for operative hip fracture. Those with pathologic or periprosthetic fractures and chronic substance use were excluded.
Outcome measures included time to operating room (TtOR), length of stay, daily and total morphine milligram equivalents, use of preoperative transthoracic echocardiogram and blood transfusions, perioperative complications (eg, urinary tract infections), and 6-month mortality.
Our study included 290 patients hospitalized with hip fracture, before (N = 128) and after (N = 162) implementation. When compared with the preimplementation group, the postimplementation comanagement group had a lower TtOR (36.2 vs. 30.0 hours, P = 0.026) and hospital length of stay, decreased use of indwelling bladder catheters preoperatively and postoperatively (68.0% vs. 46.9%, P < 0.001, and 83.6 vs. 58.0%, P < 0.001, respectively), reduced daily opiate use (16.0 vs. 11.1 morphine milligram equivalents, P = 0.011), and decreased 30-day complications (32.8% vs. 16.7%, P = 0.002). There was no difference in 6-month mortality between the 2 groups.
The implementation of an AGS CoCare:Ortho-based comanagement program led to decreased perioperative complications and resource utilization. Comanagement programs are essential to improving and standardizing hip fracture care for older adults.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估实施以老年医学为重点的骨科与住院医师共同管理项目是否能改善围手术期结局并减少资源利用。
基于美国老年医学会（AGS）的AGS CoCare:Ortho，在实施以老年医学为重点的骨科与住院医师共同管理项目前后进行了一项回顾性图表审查研究。
位于纽约大都市区的一家大型城市学术三级医疗中心。
65岁及以上因手术性髋部骨折住院的患者。排除患有病理性或假体周围骨折以及长期药物滥用的患者。
观察指标包括进入手术室的时间（TtOR）、住院时间、每日及总吗啡毫克当量、术前经胸超声心动图和输血的使用情况、围手术期并发症（如尿路感染）以及6个月死亡率。
我们的研究纳入了290例髋部骨折住院患者，实施前（N = 128）和实施后（N = 162）各一组。与实施前组相比，实施后共同管理组的TtOR更低（36.2小时对30.0小时，P = 0.026），住院时间缩短，术前和术后留置膀胱导管的使用减少（分别为68.0%对46.9%，P < 0.001，以及83.6%对58.0%，P < 0.001），每日阿片类药物使用减少（16.0对11.1吗啡毫克当量，P = 0.011），30天并发症减少（32.8%对1 .7%，P = 0.002）。两组6个月死亡率无差异。
实施基于AGS CoCare:Ortho的共同管理项目可减少围手术期并发症和资源利用。共同管理项目对于改善和规范老年髋部骨折护理至关重要。
治疗性三级。有关证据级别的完整描述，请参阅作者指南。
