引入骨科老年病学家庭访视前后的再入院和死亡率：一项髋部骨折患者的回顾性队列研究。

Readmission and mortality before and after introduction of orthogeriatric home visits: A retrospective cohort study in hip fracture patients.

机构信息

Department of Geriatric and Palliative Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 44, 2400 Copenhagen NV, Denmark.

Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nielsine Nielsens Vej 5, 2400 Copenhagen NV, Denmark.

出版信息

Injury. 2024 Dec;55(12):111937. doi: 10.1016/j.injury.2024.111937. Epub 2024 Oct 3.

DOI:10.1016/j.injury.2024.111937

PMID:39395385

Abstract

INTRODUCTION

Orthogeriatric collaboration in hip fracture patients during admission is well established, however, orthogeriatric involvement after discharge is not common. The aim of this study was to explore the association of orthogeriatric home visits with 30-day and 120-day readmission and mortality in ≥ 65-year-old patients surgically treated for hip fractures.

MATERIALS AND METHODS

A cohort of patients who underwent acute hip fracture surgery in an usual care period from January 2018 to December 2018 was compared with a cohort of patients in an intervention period from June 2020 to June 2021. During the intervention period, patients were offered orthogeriatric home visits at day 2 and 9 after discharge. The home visits were performed by orthogeriatric nurses, in close collaboration with geriatricians and orthopedic surgeons based in the local hospital. Readmission was defined as ≥ 12 h hospital stay, regardless of reason. For the main analysis, we applied Cox-regression models adjusted for age, sex, New Mobility Score, Cumulated Ambulation Score regained, cognitive function, Charlson Comorbidity Index, complications, medication, discharge destination and emergency department visits.

RESULTS

In total, 292 patients were included during the usual care period, and 308 patients during the intervention period. Thirty- and 120-day readmission rates were 27.7 % and 41.4 % in the usual care cohort vs. 21.8 % and 35.1 % in the home visit cohort. Adjusted Hazard Ratios for readmission in the intervention cohort after 30 and 120 days were 0.67 (CI95 %: 0.48-0.93) and 0.71 (CI95 %: 0.54-0.93) respectively. Thirty- and 120-day mortality rates were 7.2 % and 20.9 % in the usual care cohort versus 5.8 % and 13.3 % in the intervention cohort. Adjusted Hazard Ratios for mortality in the intervention cohort after 30 and 120 days were 0.68 (CI95 %: 0.35-1.31) and 0.56 (CI95 %: 0.37-0.84) respectively.

CONCLUSIONS

In a period where hip fracture patients were offered two home visits after discharge, we observed lower 30- and 120- day readmission, and lower 120-day mortality, calling for more studies with a randomized design.

摘要

简介

在髋部骨折患者入院期间，骨科-老年科合作已经得到很好的确立，然而，出院后的骨科-老年科介入并不常见。本研究的目的是探讨对≥65 岁接受髋关节骨折手术治疗的患者进行骨科家庭访视与 30 天和 120 天再入院和死亡率的相关性。

材料和方法

在 2018 年 1 月至 2018 年 12 月的常规护理期间，对接受急性髋部骨折手术的患者进行了队列研究，并与 2020 年 6 月至 2021 年 6 月的干预期间的患者进行了比较。在干预期间，患者在出院后第 2 天和第 9 天接受骨科家庭访视。家庭访视由骨科护士进行，与当地医院的老年病医生和骨科医生密切合作。再入院定义为≥12 小时住院治疗，无论原因如何。在主要分析中，我们应用了 Cox 回归模型，模型根据年龄、性别、新移动评分、累积移动评分恢复、认知功能、Charlson 合并症指数、并发症、药物治疗、出院地点和急诊就诊情况进行了调整。

结果

在常规护理组共纳入 292 例患者，在干预组共纳入 308 例患者。常规护理组 30 天和 120 天的再入院率分别为 27.7%和 41.4%，家庭访视组分别为 21.8%和 35.1%。干预组在第 30 天和第 120 天的调整后的再入院风险比分别为 0.67（95%CI95%：0.48-0.93）和 0.71（95%CI95%：0.54-0.93）。常规护理组 30 天和 120 天的死亡率分别为 7.2%和 20.9%，干预组分别为 5.8%和 13.3%。干预组在第 30 天和第 120 天的调整后的死亡风险比分别为 0.68（95%CI95%：0.35-1.31）和 0.56（95%CI95%：0.37-0.84）。