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Palliative Non-Operative Management in Geriatric Hip Fracture Patients: When Would Surgeons Abstain from Surgery?
Michael Bui1, Catharina G M Groothuis-Oudshoorn1, Annemieke Witteveen2
1Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, 7500 AE Enschede, The Netherlands.
Surgeons are more likely to recommend palliative non-operative management (P-NOM) for hip fracture patients with significant comorbidities. Greater decision support is needed due to substantial practice variation in these complex cases.
Area of Science:
- Geriatric Medicine
- Orthopaedic Surgery
- Surgical Decision-Making
Background:
- Hip fracture management in patients with limited life expectancy involves operative and palliative non-operative management (P-NOM).
- Similar quality of life outcomes exist between operative and P-NOM.
- Evidence guiding surgical abstention is limited.
Purpose of the Study:
- To quantify the impact of patient characteristics on surgeons' P-NOM recommendations.
- To analyze decision-making factors in hip fracture management for elderly patients.
Main Methods:
- Conjoint analysis and structured expert judgement (SEJ) were employed.
- 14 surgical residents and 9 orthopaedic trauma surgeons assessed 16 patient cases.
- Bayesian logistic regression analyzed treatment recommendations and mortality risk perceptions.
Main Results:
- Comorbidities significantly influenced P-NOM recommendations, including metastatic carcinomas, heart failure, renal failure, and dementia.
- Patients with multiple severe comorbidities received higher P-NOM recommendations.
- Perceived 30-day mortality risk for high-risk patients ranged from 50.8% to 62.7%.
Conclusions:
- Comorbidities are the primary driver for recommending P-NOM in hip fracture patients.
- Significant practice variation and heterogeneity in risk perception exist among surgeons.
- Enhanced decision support tools are necessary for P-NOM consideration in hip fracture care.
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