Around one in ten patients suffering a proximal femoral fracture die within thirty days. A team of medical specialists at the trauma and orthopaedic surgery unit, Nottingham University Hospitals (UK), has developed a multidisciplinary approach for elderly inpatients. Presenting data on this “comprehensive care package” at the 14th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) in Istanbul, the team was able to demonstrate improved outcomes for patients and a reduction in the cost of care. At this meeting, about 7,500 experts are currently discussing latest developments in their field.
The orthogeriatric service set up at Nottingham University Hospitals at the moment covers only inpatients. A member of the team attends all morning trauma meetings, and subsequently reviews all elderly patients with proximal femoral fractures prior to their surgery, said study author Mark Gaden. “Any patients with particularly urgent medical issues will be flagged as a priority,” he said. Neck of femur patients will also be seen post-operatively by the orthogeriatric team who will assist in their general management as well as management of medical complications, falls prevention, bone health, dementia screening and discharge planning.” The team are also available for advice on managing any elderly patients with acute medical problems. “The multidisciplinary team comprises the orthopaedic medical team, physiotherapists, occupational therapists, nurses and nursing assistants, discharge coordinators and osteoporosis nurse specialists,” said Gaden.
Lower mortality rates, earlier intervention
Data was compared from patients admitted the year prior to instigation of a comprehensive care package to those patients admitted one year after, to evaluate the effectiveness of the orthogeriatric team’s interventions. This involved 1,642 patients with fracture of the proximal femur admitted during the study period. 813 patients were admitted under the old model of care and 829 under the new system. The 30 day mortality rate dropped from 9.23% to 8.44%. At the same time, the care package meant patients were operated on more quickly, with 70% undergoing surgery within 40 hours compared to 55% before. Speedier surgical intervention is the key, said Gaden. “Delaying theatre has been shown to increase complications, particularly chest infections and pressure sores in this group of patients,” he said. “The pre-operative input from the orthogeriatric team is very much directed towards rapid and effective optimisation of the patient’s medical condition with a view to early operative intervention.”
Meanwhile, the most significant factors in the care package leading to a reduction in postoperative complications, and thus mortality, length of hospital stay and care costs are, Gaden said, “optimising patients early for surgery, early mobilisation and regular multidisciplinary review.” Introducing a comprehensive package of orthogeriatric care should be considered at other units, said the NUH team. “We have found that the introduction of this service has improved outcomes for our patients and would therefore recommend such a service for units treating proximal femoral fractures,” said Gaden.
European Federation of National Associations of Orthopaedics and Traumatology (EFORT)