Drevet Sabine, Tonetti Jérôme, Bouzat Pierre, Boudissa Mehdi, Greze Jules, Fajfrova Olga, Allan-Pattoglia Laure, Olive Frederic, Bouisse Magali, Boussat Bastien, Bioteau Catherine, Gavazzi Gaetan
University of Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Clinic of Geriatric Medicine Department, Boulevard de La Chantourne, Grenoble, 38000, France.
University of Grenoble Alpes, University Hospital Grenoble Alpes, Orthogeriatric Unit, Orthopaedic and Traumatology Surgery Department, Grenoble, 38000, France.
BMC Geriatr. 2025 Jul 11;25(1):515. doi: 10.1186/s12877-025-06156-5.
In hip fracture, the interval between admission and surgery, referred to as time to surgery (TTS) influences prognosis. The main objectives of trauma management in older patients regardless of the orthogeriatric care model is to reduce the TTS between 24 and 48 h to improve outcomes. Our study aimed to assess the impact of orthogeriatric care models on TTS and patient outcomes in older patients with hip fracture.
Observational, retrospective, monocentric study divided into three sequential periods corresponding to three models of care implemented in a French Orthogeriatric unit from August 2015 to October 2021: Period 1 with a Geriatric Consultant Service in Orthopaedic Unit (GCS); Period 2 with an Integrated Orthogeriatric Care Model (ICM); Period 3 with an Integrated Orthogeriatric Care model with Anaesthetist (ICMA). The primary endpoint was the TTS assessed by the time elapsed from the emergency department admission to surgery start time in older patients with hip fracture (75 ≤ years old). The second objective was to assess the association of each model on patient outcomes: medical complications and health status at discharge. Comparisons between groups at baseline were performed using the Kruskal-Wallis test for continuous variables or the Chi test for nominal variables. The significative threshold was set at 0.05.
490 patients (mean age, 88.2 years (SD, 5.8); female: 74.5%) were included: n = 147, 148, and 195 for GCS, ICM, and ICMA respectively. Comorbidity scores were more severe in ICMA. Median TTS was 52 h (IQR, 36-81), 53 h (24-98), and 44 h (25-67) for GCS, ICM, and ICMA respectively (p = 0.01). Regional nerve blocks were enhanced from 10.9% to 70.3% (p = < 0.001). Several in-hospital medical complications increased but delirium decreased in ICMA compared to GCS (p = 0.02). The mortality rate remained stable (5.5%). The length of stay did not differ between models. At discharge, 81.4% of patients from ICMA could walk at least 3 m.
TTS during the Integrated Orthogeriatric Care model with Anaesthetist decreased despite increased comorbidities and anticoagulation treatments. The model improved hip fracture management process and patient outcomes. Monitoring TTS is key to finding the optimal model, but strong professional values and structures are vital.
在髋部骨折中，入院至手术的间隔时间，即手术时间（TTS）会影响预后。无论采用何种老年骨科护理模式，老年患者创伤管理的主要目标都是将TTS缩短至24至48小时以内，以改善治疗效果。我们的研究旨在评估老年骨科护理模式对髋部骨折老年患者TTS及患者治疗效果的影响。
本研究为观察性、回顾性、单中心研究，分为三个连续阶段，对应2015年8月至2021年10月在法国一家老年骨科病房实施的三种护理模式：第一阶段为骨科病房的老年顾问服务（GCS）；第二阶段为综合老年骨科护理模式（ICM）；第三阶段为有麻醉师参与的综合老年骨科护理模式（ICMA）。主要终点是通过髋部骨折老年患者（年龄≥75岁）从急诊科入院到手术开始时间来评估的TTS。第二个目标是评估每种模式与患者治疗效果的关联：医疗并发症及出院时的健康状况。连续变量组间比较采用Kruskal-Wallis检验，名义变量采用卡方检验。显著性阈值设定为0.05。
共纳入490例患者（平均年龄88.2岁（标准差5.8）；女性占74.�%）：GCS组、ICM组和ICMA组分别为147例、148例和195例。ICMA组合并症评分更严重。GCS组、ICM组和ICMA组的TTS中位数分别为52小时（四分位间距36 - 81）、53小时（24 - 98）和44小时（25 - 67）（p = 0.01）。区域神经阻滞从10.9%增加到70.3%（p < 0.001）。与GCS组相比，ICMA组院内几种医疗并发症增加，但谵妄减少（p = 0.02）。死亡率保持稳定（5.5%）。各模式间住院时间无差异。出院时，ICMA组81.4%的患者能够至少行走3米。
在有麻醉师参与的综合老年骨科护理模式下，尽管合并症和抗凝治疗增加，但TTS缩短。该模式改善了髋部骨折的管理流程及患者治疗效果。监测TTS是找到最佳模式的关键，但强大的专业价值观和架构也至关重要。
