Hayward-Livingston Anna, Ozdag Yagiz, Kolessar David, Weinberg Jacob, Pamul Arpitha, Koury Kenneth, Balsamo Anthony
Geisinger Musculoskeletal Institute, Geisinger Wyoming Valley, Wilkes Barre, PA, USA.
Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
Geriatr Orthop Surg Rehabil. 2024 Aug 9;15:21514593241273155. doi: 10.1177/21514593241273155. eCollection 2024.
Increasing incidence of fragility fractures has spurred development of protocols, largely focused on peri-operative care, with numerous proven benefits. The purpose of this investigation was to evaluate outcomes of our hip fracture treatment program regarding successful protocol implementation, compliance, effect on subsequent fracture rates, and mortality during the first decade of adoption.
A retrospective review identified patients >65 years old with fragility hip fractures between 2010 and 2022. The HiROC (+) cohort consisted of patients who received a "High-Risk Osteoporosis Clinic" (HiROC) referral for bone health evaluation and bisphosphonate initiation as indicated. Additional fracture rates and mortality at 3 years were calculated. Protocol implementation and compliance over the first 10 years was analyzed in the four identified cohorts.
A total of 1671 fragility hip fractures were identified, with 386 excluded due to insufficient follow-up, with an average age of 81.6 years and a median follow-up of 36.4 months. Of the 1280 included cases, 56% (n = 717) had a HiROC referral placed. HiROC(+) groups had lower subsequent fracture rates at two years, compared to those without referral (28% vs 13%, < 0.0001) and those completing more steps of the protocol had lower subsequent fracture rates (28% vs 15% vs 13% vs 5%, < 0.0001). No statistically significant difference was observed between the cohorts for anatomic site of subsequent fractures.
Greater than half of all eligible patients were successfully captured by the protocol. Patients completing more steps of the protocol had lower subsequent fracture rates. Captured patients demonstrated reduced mortality rates when compared to current literature.
Successful implementation of this geriatric hip fracture protocol was associated with reduced additional fractures and mortality rates. Identifying steps of process failures in the protocol can provide opportunities for increased compliance and reduction in future fracture occurrences.
脆性骨折发病率的不断上升推动了相关治疗方案的制定，这些方案主要侧重于围手术期护理，已被证明有诸多益处。本研究的目的是评估我们的髋部骨折治疗方案在成功实施、依从性、对后续骨折发生率的影响以及采用该方案后的头十年内的死亡率方面的效果。
一项回顾性研究确定了2010年至2022年间年龄大于65岁的脆性髋部骨折患者。HiROC(+)队列包括那些因骨健康评估和必要时启动双膦酸盐治疗而接受“高危骨质疏松诊所”（HiROC）转诊的患者。计算了3年时的额外骨折发生率和死亡率。对四个确定的队列在头10年的方案实施情况和依从性进行了分析。
共确定了1671例脆性髋部骨折，其中386例因随访不足而被排除，平均年龄为81.6岁，中位随访时间为36.4个月。在1280例纳入病例中，56%（n = 717）有HiROC转诊。与未转诊的患者相比，HiROC(+)组在两年时的后续骨折发生率较低（28%对13%，P < 0.0001），并且完成方案更多步骤的患者后续骨折发生率更低（28%对15%对13%对5%，P < 0.0001）。各队列之间在后续骨折的解剖部位方面未观察到统计学上的显著差异。
该方案成功涵盖了超过一半的符合条件的患者。完成方案更多步骤的患者后续骨折发生率较低。与当前文献相比，被纳入方案的患者死亡率有所降低。
该老年髋部骨折方案的成功实施与额外骨折和死亡率的降低相关。识别方案中的流程失败步骤可为提高依从性和减少未来骨折发生提供机会。
