Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.

Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.

<h4>Background</h4>Elderly patients with hip fracture have a 5 to 8 fold increased risk of death during the months following surgery. We tested the hypothesis that early geriatric management of these patients focused on co-morbidities and rehabilitation improved long term mortality.<h...

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Autores principales: Jacques Boddaert, Judith Cohen-Bittan, Frédéric Khiami, Yannick Le Manach, Mathieu Raux, Jean-Yves Beinis, Marc Verny, Bruno Riou
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2014
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Acceso en línea:https://doaj.org/article/fa94d8be82454993a953b4c074b7f479
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spelling oai:doaj.org-article:fa94d8be82454993a953b4c074b7f4792021-11-18T08:37:47ZPostoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.1932-620310.1371/journal.pone.0083795https://doaj.org/article/fa94d8be82454993a953b4c074b7f4792014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24454708/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Elderly patients with hip fracture have a 5 to 8 fold increased risk of death during the months following surgery. We tested the hypothesis that early geriatric management of these patients focused on co-morbidities and rehabilitation improved long term mortality.<h4>Methods and findings</h4>In a cohort study over a 6 year period, we compared patients aged >70 years with hip fracture admitted to orthopedic versus geriatric departments in a time series analysis corresponding to the creation of a dedicated geriatric unit. Co-morbidities were assessed using the Cumulative Illness Rating Scale (CIRS). Each cohort was compared to matched cohorts extracted from a national registry (n = 51,275) to validate the observed results. Main outcome measure was 6-month mortality. We included 131 patients in the orthopedic cohort and 203 in the geriatric cohort. Co-morbidities were more frequent in the geriatric cohort (median CIRS: 8 vs 5, P<0.001). In the geriatric cohort, the proportion of patients who never walked again decreased (6% versus 22%, P<0.001). At 6 months, re-admission (14% versus 29%, P = 0.007) and mortality (15% versus 24%, P = 0.04) were decreased. When co-morbidities were taken into account, the risk ratio of death at 6 months was reduced (0.43, 95%CI 0.25 to 0.73, P = 0.002). Using matched cohorts, the average treatment effects on the treated associated to early geriatric management indicated a reduction in hospital mortality (-63%; 95% CI: -92% to -6%, P = 0.006).<h4>Conclusions</h4>Early admission to a dedicated geriatric unit improved 6-month mortality and morbidity in elderly patients with hip fracture.Jacques BoddaertJudith Cohen-BittanFrédéric KhiamiYannick Le ManachMathieu RauxJean-Yves BeinisMarc VernyBruno RiouPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 1, p e83795 (2014)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Jacques Boddaert
Judith Cohen-Bittan
Frédéric Khiami
Yannick Le Manach
Mathieu Raux
Jean-Yves Beinis
Marc Verny
Bruno Riou
Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.
description <h4>Background</h4>Elderly patients with hip fracture have a 5 to 8 fold increased risk of death during the months following surgery. We tested the hypothesis that early geriatric management of these patients focused on co-morbidities and rehabilitation improved long term mortality.<h4>Methods and findings</h4>In a cohort study over a 6 year period, we compared patients aged >70 years with hip fracture admitted to orthopedic versus geriatric departments in a time series analysis corresponding to the creation of a dedicated geriatric unit. Co-morbidities were assessed using the Cumulative Illness Rating Scale (CIRS). Each cohort was compared to matched cohorts extracted from a national registry (n = 51,275) to validate the observed results. Main outcome measure was 6-month mortality. We included 131 patients in the orthopedic cohort and 203 in the geriatric cohort. Co-morbidities were more frequent in the geriatric cohort (median CIRS: 8 vs 5, P<0.001). In the geriatric cohort, the proportion of patients who never walked again decreased (6% versus 22%, P<0.001). At 6 months, re-admission (14% versus 29%, P = 0.007) and mortality (15% versus 24%, P = 0.04) were decreased. When co-morbidities were taken into account, the risk ratio of death at 6 months was reduced (0.43, 95%CI 0.25 to 0.73, P = 0.002). Using matched cohorts, the average treatment effects on the treated associated to early geriatric management indicated a reduction in hospital mortality (-63%; 95% CI: -92% to -6%, P = 0.006).<h4>Conclusions</h4>Early admission to a dedicated geriatric unit improved 6-month mortality and morbidity in elderly patients with hip fracture.
format article
author Jacques Boddaert
Judith Cohen-Bittan
Frédéric Khiami
Yannick Le Manach
Mathieu Raux
Jean-Yves Beinis
Marc Verny
Bruno Riou
author_facet Jacques Boddaert
Judith Cohen-Bittan
Frédéric Khiami
Yannick Le Manach
Mathieu Raux
Jean-Yves Beinis
Marc Verny
Bruno Riou
author_sort Jacques Boddaert
title Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.
title_short Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.
title_full Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.
title_fullStr Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.
title_full_unstemmed Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.
title_sort postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.
publisher Public Library of Science (PLoS)
publishDate 2014
url https://doaj.org/article/fa94d8be82454993a953b4c074b7f479
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AT brunoriou postoperativeadmissiontoadedicatedgeriatricunitdecreasesmortalityinelderlypatientswithhipfracture
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