Medical Research: What is the background for this study? What are the main findings?
Dr. Saltvedt: Hip fracture patients are often old, frail and have many comorbidities. When treated with a traditional orthopaedic approach the outcomes are often poor, and many patients get functionally impaired with reduced ability to walk independently and impairment in daily life activities and with high costs for the society. In many ways these patients are geriatric patients with hip-fractures. It has previously been shown that acutely sick geriatric patients benefit from treatment in geriatric wards and different kind of orthogeriatric treatment models where orthopaedic surgeons and geriatricians collaborate have been studied and have shown beneficial results on short term outcomes. In the present study patients home-dwelling hip-fracture patients were randomised to orthogeriatric treatment or traditional orthopaedic treatment from admission to the hospital and during the entire stay except for the surgery that was performed similar in both groups. The study focused on long-term outcomes and also on use of health care services and cost-effectiveness. Patients in the orthogeriatric group got comprehensive geriatric assessment and treatment performed by an interdisciplinary team that emphasised early mobilisation and rehabilitation and started discharge planning early. In the orthopaedic group traditional treatment according to national and international guidelines was offered.
The primary endpoint was mobility at four months, that was better in the orthogeriatric group than in the orthopaedic group, the same difference was also shown at 12 months. In addition there were differences in instrumental activities of daily living and personal activities of daily living, quality of life and fear of falling, all differences were statistically and clinically significant and in favour of the orthoegeriatric group. The length of hospital stay was 1,7 days longer in the geriatric group, while there was no differences in days spent in hospital during one year of follow-up. One of four orthogeriatric patients were discharged directly home as compared to one of ten in the orthopaedic group. The orthopaedic group spent more days in nursing homes and rehabilitation institutions during one year of follow-up. The treatment was cost-effective in favour of the orthogeriatric group.
Medical Research: What should clinicians and patients take away from your report?
Dr. Saltvedt: Outcomes can be improved when hip-fractures are treated with an orthogeriatric approach from admission to hospital.
Although we think that our results are valid also outside our hospital, the present study is a single centre study that should be followed by a multicentre study to be sure that the results are valid in other settings and other countries. There is also need of further research on how to treat these patients both during the hospital stay and afterward in order to improve outcomes for patients and save costs for the society.
Anders Prestmo, MD Gunhild Hagen, MPhil Olav Sletvold, PhD
Prof Jorunn L Helbostad, PhD Pernille Thingstad, MSc Kristin Taraldsen, PhD Prof Stian Lydersen, PhD Vidar Halsteinli, PhD Turi Saltnes, MScProf Sarah E Lamb, PhD Lars G
MedicalResearch.com Interview with:, & Ingvild Saltvedt PhD (2015). Hip Fractures: Comprehensive Geriatric Care Improved Outcomes and Reduced Costs MedicalResearch.com