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Do standardized hip fracture care programs decrease mortality in geriatric hip fracture patients?

Aresh Sepehri1, Nathan N O'Hara1, Gerard P Slobogean1

  • 1Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.

Injury
|October 13, 2020
PubMed
Summary
This summary is machine-generated.

Standardized hip fracture programs (SHFPs) show no overall benefit for geriatric patients. However, SHFPs may reduce 30-day mortality risk in higher-risk hip fracture patients, suggesting targeted deployment could improve efficiency.

Keywords:
FrailGeriatricHip fracturesStandardized care pathway

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Area of Science:

  • Geriatric Medicine
  • Orthopedic Surgery
  • Public Health

Background:

  • Growing support exists for standardized hip fracture programs (SHFPs) for elderly patients.
  • Existing evidence on SHFP effectiveness is limited to small, single-center observational studies.
  • Assessing SHFP impact on 30-day patient outcomes in a large, multinational cohort is needed.

Purpose of the Study:

  • To determine if geriatric hip fracture patients in an SHFP have improved 30-day outcomes.
  • To evaluate if SHFP treatment effects differ based on baseline mortality risk.

Main Methods:

  • An observational cohort study utilized 2016-2017 National Surgical Quality Improvement Program (NSQIP) data.
  • Included 17,395 geriatric hip fracture patients (age > 65); 54% were in an SHFP.
  • Multivariable logistic regression analyzed 30-day mortality, reoperation, and readmission, adjusting for covariates and stratifying by mortality risk.

Main Results:

  • Overall, SHFPs did not significantly reduce 30-day mortality, reoperation, or readmission.
  • A significant mortality reduction was observed in the highest risk quartile (2.0%) and medium-high risk quartile (1.7%).
  • SHFP treatment effects varied significantly by baseline mortality risk.

Conclusions:

  • Standardized hip fracture programs do not significantly improve short-term outcomes for the average geriatric hip fracture patient.
  • Targeted SHFP implementation for high-risk geriatric hip fracture patients may improve outcomes.
  • Future research should focus on optimizing SHFP deployment for high-risk populations.