$Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning$
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Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

Background and purpose — Surgical treatment is still the mainstay of care even in very frail elderly hip fracture patients. However, one may argue whether surgery is in the best interest of all patients. We elucidated mortality rates of nonoperative management (NOM) of a hip fracture after shared de...

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Autores principales:	Hugo H Wijnen, Peter P Schmitz, Houda Es-Safraouy, Lian A Roovers, Diana G Taekema, Job L C Van Susante
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/98c6eb937f8442a18f3b9833f62b226c
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spelling	oai:doaj.org-article:98c6eb937f8442a18f3b9833f62b226c2021-11-26T11:19:48ZNonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning1745-36741745-368210.1080/17453674.2021.1959155https://doaj.org/article/98c6eb937f8442a18f3b9833f62b226c2021-10-01T00:00:00Zhttp://dx.doi.org/10.1080/17453674.2021.1959155https://doaj.org/toc/1745-3674https://doaj.org/toc/1745-3682Background and purpose — Surgical treatment is still the mainstay of care even in very frail elderly hip fracture patients. However, one may argue whether surgery is in the best interest of all patients. We elucidated mortality rates of nonoperative management (NOM) of a hip fracture after shared decision-making in a cohort of very frail elderly patients. Patients and methods — Orthogeriatric patients (age > 70 years) admitted with a hip fracture between 2011 and 2019 were included. In the presence of fragility features the motivation for surgery or NOM was supported by advance care planning (ACP) and shared decision-making through geriatric assessment. Mortality rates after NOM were assessed and also presented for the remaining surgical group for reference. Results — In 1,279 out of 3,467 patients, geriatric assessment was indicated and subsequently 1,188 (93%) had surgery versus 91 (7%) NOM. The motivation for NOM was based on patient and family preferences in only 20% of patients, medical grounds in 54%, and a combination of both in 26%. The 30-day and 1-year mortality in the frail NOM group was 87% and 99% respectively, whereas this was 7% and 28% in the surgery group. No statistical comparison between groups was performed due to profound bias by indication. Interpretation — This study provides further insight into the predictable and high short-term mortality after NOM in carefully selected very frail elderly hip fracture patients. This information may help to consider NOM as an alternative treatment option to surgery when no significant gain from surgery is anticipated.Hugo H WijnenPeter P SchmitzHouda Es-SafraouyLian A RooversDiana G TaekemaJob L C Van SusanteTaylor & Francis GrouparticleOrthopedic surgeryRD701-811ENActa Orthopaedica, Vol 92, Iss 6, Pp 728-732 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Hugo H Wijnen Peter P Schmitz Houda Es-Safraouy Lian A Roovers Diana G Taekema Job L C Van Susante Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning
description	Background and purpose — Surgical treatment is still the mainstay of care even in very frail elderly hip fracture patients. However, one may argue whether surgery is in the best interest of all patients. We elucidated mortality rates of nonoperative management (NOM) of a hip fracture after shared decision-making in a cohort of very frail elderly patients. Patients and methods — Orthogeriatric patients (age > 70 years) admitted with a hip fracture between 2011 and 2019 were included. In the presence of fragility features the motivation for surgery or NOM was supported by advance care planning (ACP) and shared decision-making through geriatric assessment. Mortality rates after NOM were assessed and also presented for the remaining surgical group for reference. Results — In 1,279 out of 3,467 patients, geriatric assessment was indicated and subsequently 1,188 (93%) had surgery versus 91 (7%) NOM. The motivation for NOM was based on patient and family preferences in only 20% of patients, medical grounds in 54%, and a combination of both in 26%. The 30-day and 1-year mortality in the frail NOM group was 87% and 99% respectively, whereas this was 7% and 28% in the surgery group. No statistical comparison between groups was performed due to profound bias by indication. Interpretation — This study provides further insight into the predictable and high short-term mortality after NOM in carefully selected very frail elderly hip fracture patients. This information may help to consider NOM as an alternative treatment option to surgery when no significant gain from surgery is anticipated.
format	article
author	Hugo H Wijnen Peter P Schmitz Houda Es-Safraouy Lian A Roovers Diana G Taekema Job L C Van Susante
author_facet	Hugo H Wijnen Peter P Schmitz Houda Es-Safraouy Lian A Roovers Diana G Taekema Job L C Van Susante
author_sort	Hugo H Wijnen
title	Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning
title_short	Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning
title_full	Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning
title_fullStr	Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning
title_full_unstemmed	Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning
title_sort	nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning
publisher	Taylor & Francis Group
publishDate	2021
url	https://doaj.org/article/98c6eb937f8442a18f3b9833f62b226c
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Nonoperative management of hip fractures in very frail elderly patients may lead to a predictable short survival as part of advance care planning

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