Impact of three sequential orthogeriatric care models on time to surgery after hip fracture: a retrospective study.

Abstract

Background: In hip fracture, the interval between admission and surgery, referred to as time to surgery (TTS) influences prognosis. The main objectives of trauma management in older patients regardless of the orthogeriatric care model is to reduce the TTS between 24 and 48 h to improve outcomes. Our study aimed to assess the impact of orthogeriatric care models on TTS and patient outcomes in older patients with hip fracture.

Methods: Observational, retrospective, monocentric study divided into three sequential periods corresponding to three models of care implemented in a French Orthogeriatric unit from August 2015 to October 2021: Period 1 with a Geriatric Consultant Service in Orthopaedic Unit (GCS); Period 2 with an Integrated Orthogeriatric Care Model (ICM); Period 3 with an Integrated Orthogeriatric Care model with Anaesthetist (ICMA). The primary endpoint was the TTS assessed by the time elapsed from the emergency department admission to surgery start time in older patients with hip fracture (75 ≤ years old). The second objective was to assess the association of each model on patient outcomes: medical complications and health status at discharge. Comparisons between groups at baseline were performed using the Kruskal-Wallis test for continuous variables or the Chi² test for nominal variables. The significative threshold was set at 0.05.

Results: 490 patients (mean age, 88.2 years (SD, 5.8); female: 74.5%) were included: n = 147, 148, and 195 for GCS, ICM, and ICMA respectively. Comorbidity scores were more severe in ICMA. Median TTS was 52 h (IQR, 36-81), 53 h (24-98), and 44 h (25-67) for GCS, ICM, and ICMA respectively (p = 0.01). Regional nerve blocks were enhanced from 10.9% to 70.3% (p = < 0.001). Several in-hospital medical complications increased but delirium decreased in ICMA compared to GCS (p = 0.02). The mortality rate remained stable (5.5%). The length of stay did not differ between models. At discharge, 81.4% of patients from ICMA could walk at least 3 m.

Conclusions: TTS during the Integrated Orthogeriatric Care model with Anaesthetist decreased despite increased comorbidities and anticoagulation treatments. The model improved hip fracture management process and patient outcomes. Monitoring TTS is key to finding the optimal model, but strong professional values and structures are vital.