In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre

<i>Background and Objectives</i>: The implementation of orthogeriatric co-management (OGCM) reflects the demand for interdisciplinary collaborations due to the increasing comorbidities of geriatric trauma patients. This study aimed to assess clinical in-hospital outcomes in lumbar spine,...

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Autores principales:	Markus Laubach, Laura Christine Gruchow, Tobias Hafner, Filippo Migliorini, Matthias Knobe, Frank Hildebrand, Miguel Pishnamaz
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	fragility fracture elderly geriatric trauma centre orthogeriatric co-management Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/009dc0f540374395b85abef2c53dc972
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spelling	oai:doaj.org-article:009dc0f540374395b85abef2c53dc9722021-11-25T18:18:30ZIn-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre10.3390/medicina571111971648-91441010-660Xhttps://doaj.org/article/009dc0f540374395b85abef2c53dc9722021-11-01T00:00:00Zhttps://www.mdpi.com/1648-9144/57/11/1197https://doaj.org/toc/1010-660Xhttps://doaj.org/toc/1648-9144<i>Background and Objectives</i>: The implementation of orthogeriatric co-management (OGCM) reflects the demand for interdisciplinary collaborations due to the increasing comorbidities of geriatric trauma patients. This study aimed to assess clinical in-hospital outcomes in lumbar spine, thoracic spine, and pelvic ring fragility fracture patients before and after the implementation of a Geriatric Trauma Centre (GTC) certified by the German Trauma Society (DGU<sup>®</sup>). <i>Materials and Methods</i>: In this observational, retrospective cohort study, geriatric trauma patients (>70 years of age) were stratified into either a pre-GTC group (hospital admission between 1 January 2012 and 31 December 2013) or a post-GTC group (hospital admission between 1 January 2017 and 31 December 2018). Patients’ pre-injury medical complexity was measured by ASA class (American Society of Anaesthesiologists classification), the use of anticoagulant medication, and the ACCI (Age-adjusted Charlson Comorbidity Index). Outcome parameters were patients’ in-hospital length of stay (LOS) and mortality rates, as well as new in-hospital findings and diagnoses. Further, the necessity of deviation from initial management plans due to complications was assessed using the Adapted Clavien–Dindo Scoring System in Trauma (ACDiT score of ≥1). <i>Results</i>: Patients in the post-GTC group (<i>n</i> = 111) were older (median age 82.0 years) compared to the pre-GTC group (<i>n</i> = 108, median age 80.0 years, <i>p</i> = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all <i>p</i> > 0.05). Patients in the post-GTC group used vitamin K antagonists or direct oral anticoagulants more frequently (21.3% versus 10.8%). The incidence of non-surgical treatment and mortality was comparable between groups, while LOS tended to be shorter in the post-GTC group (7.0 days versus 9.0 days, <i>p</i> = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, <i>p</i> = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, <i>p</i> = 0.094), while an ACDiT score of ≥1 was comparable between groups (<i>p</i> = 0.169). <i>Conclusions</i>: In this study including lumbar spine, thoracic spine, and pelvic ring geriatric fragility fractures, patients in the post-GTC group were more medically complex. More UTIs and the tendency for increased delirium detection was observed in the post-GTC group, likely due to improved diagnostic testing. Nonetheless, the necessity of deviation from initial management plans (ACDiT score of ≥1) was comparable between groups, potentially a positive result of OGCM.Markus LaubachLaura Christine GruchowTobias HafnerFilippo MiglioriniMatthias KnobeFrank HildebrandMiguel PishnamazMDPI AGarticlefragility fractureelderlygeriatric trauma centreorthogeriatric co-managementMedicine (General)R5-920ENMedicina, Vol 57, Iss 1197, p 1197 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	fragility fracture elderly geriatric trauma centre orthogeriatric co-management Medicine (General) R5-920
spellingShingle	fragility fracture elderly geriatric trauma centre orthogeriatric co-management Medicine (General) R5-920 Markus Laubach Laura Christine Gruchow Tobias Hafner Filippo Migliorini Matthias Knobe Frank Hildebrand Miguel Pishnamaz In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre
description	<i>Background and Objectives</i>: The implementation of orthogeriatric co-management (OGCM) reflects the demand for interdisciplinary collaborations due to the increasing comorbidities of geriatric trauma patients. This study aimed to assess clinical in-hospital outcomes in lumbar spine, thoracic spine, and pelvic ring fragility fracture patients before and after the implementation of a Geriatric Trauma Centre (GTC) certified by the German Trauma Society (DGU<sup>®</sup>). <i>Materials and Methods</i>: In this observational, retrospective cohort study, geriatric trauma patients (>70 years of age) were stratified into either a pre-GTC group (hospital admission between 1 January 2012 and 31 December 2013) or a post-GTC group (hospital admission between 1 January 2017 and 31 December 2018). Patients’ pre-injury medical complexity was measured by ASA class (American Society of Anaesthesiologists classification), the use of anticoagulant medication, and the ACCI (Age-adjusted Charlson Comorbidity Index). Outcome parameters were patients’ in-hospital length of stay (LOS) and mortality rates, as well as new in-hospital findings and diagnoses. Further, the necessity of deviation from initial management plans due to complications was assessed using the Adapted Clavien–Dindo Scoring System in Trauma (ACDiT score of ≥1). <i>Results</i>: Patients in the post-GTC group (<i>n</i> = 111) were older (median age 82.0 years) compared to the pre-GTC group (<i>n</i> = 108, median age 80.0 years, <i>p</i> = 0.016). No differences were found in sex, body mass index, ASA class, or ACCI (all <i>p</i> > 0.05). Patients in the post-GTC group used vitamin K antagonists or direct oral anticoagulants more frequently (21.3% versus 10.8%). The incidence of non-surgical treatment and mortality was comparable between groups, while LOS tended to be shorter in the post-GTC group (7.0 days versus 9.0 days, <i>p</i> = 0.076). In the post-GTC group, the detection of urinary tract infections (UTI) increased (35.2% versus 16.2%, <i>p</i> = 0.001), and the delirium diagnoses tended to increase (13.0% versus 6.3%, <i>p</i> = 0.094), while an ACDiT score of ≥1 was comparable between groups (<i>p</i> = 0.169). <i>Conclusions</i>: In this study including lumbar spine, thoracic spine, and pelvic ring geriatric fragility fractures, patients in the post-GTC group were more medically complex. More UTIs and the tendency for increased delirium detection was observed in the post-GTC group, likely due to improved diagnostic testing. Nonetheless, the necessity of deviation from initial management plans (ACDiT score of ≥1) was comparable between groups, potentially a positive result of OGCM.
format	article
author	Markus Laubach Laura Christine Gruchow Tobias Hafner Filippo Migliorini Matthias Knobe Frank Hildebrand Miguel Pishnamaz
author_facet	Markus Laubach Laura Christine Gruchow Tobias Hafner Filippo Migliorini Matthias Knobe Frank Hildebrand Miguel Pishnamaz
author_sort	Markus Laubach
title	In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre
title_short	In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre
title_full	In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre
title_fullStr	In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre
title_full_unstemmed	In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre
title_sort	in-hospital clinical outcomes in patients with fragility fractures of the lumbar spine, thoracic spine, and pelvic ring: a comparison of data before and after certification as a dgu<sup>®</sup> geriatric trauma centre
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/009dc0f540374395b85abef2c53dc972
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In-Hospital Clinical Outcomes in Patients with Fragility Fractures of the Lumbar Spine, Thoracic Spine, and Pelvic Ring: A Comparison of Data before and after Certification as a DGU<sup>®</sup> Geriatric Trauma Centre

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