Rodríguez Álvarez Ana, López-Castro José, Cambón Cotelo Javier, Quevedo Vila Victor, Marchán-López Álvaro
Internal Medicine Department, Hospital Universitario Lucus Augusti, Lugo, Spain.
Internal Medicine Department, Hospital Público de Monforte, Rua Corredoira s/n, Monforte de Lemos, 27400, Lugo, Spain.
Eur J Trauma Emerg Surg. 2025 Jan 17;51(1):23. doi: 10.1007/s00068-024-02737-y.
Hip fractures represent a serious public health problem with a high burden of mortality, morbidity, and resource use. Co-management has proven to enhance the clinical outcomes of hip fracture patients hospitalized in various settings.
This study aims to evaluate whether the previously observed benefits of co-management can be achieved when such a program is implemented in a rural-based district hospital.
A prospective, single-center observational study was conducted on hip fracture patients hospitalized for hip fracture. Patients were either co-managed by an internal medicine specialist with part-time dedication or not co-managed. The study was conducted in a rural hospital located in Galicia, Northwestern Spain, which serves a population of 45,000.
A total of 207 patients were included in the study, of whom 97 received co-management. The majority of the patients who were co-managed were female (69.1%) and had a median age of 88 years (interquartile range 83-92). The study showed a high burden of comorbidity with a median Charlson index of 6 points, along with high prevalence rates of dementia (46%), functional disability (50%), and chronic anticoagulant therapy (25%). Despite no differences in age, sex, or preadmission cognitive or functional status, the study found lower 30-day postdischarge mortality in co-managed patients (9.3%) compared with the 110 controls (20.0%, p = 0.049). The prevalence of osteoporosis treatment, both calcium/vitamin D (87.8% vs. 60.7%, p < 0.001) and bisphosphonates/denosumab/teriparatide (42.4% vs. 15.7%, p < 0.001), was higher in the co-managed patients at 30 days after discharge. No differences were observed between the two groups in terms of in-hospital mortality and length of stay.
The implementation of internal medicine co-management for hip fracture patients resulted in enhanced outcomes, particularly in the reduction of mortality within 30 days of discharge as well as in the prevalence of osteoporosis treatment.
髋部骨折是一个严重的公共卫生问题，在死亡率、发病率和资源利用方面负担沉重。共同管理已被证明可改善在各种环境中住院的髋部骨折患者的临床结局。
本研究旨在评估在一家农村地区医院实施此类项目时，能否实现先前观察到的共同管理的益处。
对因髋部骨折住院的患者进行了一项前瞻性、单中心观察性研究。患者要么由兼职的内科专家进行共同管理，要么不进行共同管理。该研究在西班牙西北部加利西亚的一家农村医院进行，该医院服务人口为45000人。
共有207名患者纳入研究，其中97名接受了共同管理。接受共同管理的患者大多数为女性（69.1%），中位年龄为88岁（四分位间距83 - 92岁）。研究显示合并症负担较高，查尔森指数中位数为6分，同时痴呆症（46%）、功能残疾（50%）和慢性抗凝治疗（25%）的患病率也较高。尽管在年龄、性别或入院前认知或功能状态方面没有差异，但研究发现共同管理的患者出院后30天死亡率（9.3%）低于110名对照患者（20.0%，p = 0.049）。出院30天时，共同管理的患者中骨质疏松治疗的患病率，无论是钙/维生素D（87.8%对60.7%，p < 0.001）还是双膦酸盐/地诺单抗/特立帕肽（42.4%对15.7%，p < 0.001）都更高。两组在院内死亡率和住院时间方面未观察到差异。
对髋部骨折患者实施内科共同管理可改善结局，特别是降低出院后30天内的死亡率以及提高骨质疏松治疗的患病率。
