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Observational Study
. 2020 Jan 24;117(4):53-59.
doi: 10.3238/arztebl.2020.0053.

The Association Between Orthogeriatric Co-Management and Mortality Following Hip Fracture

Kilian Rapp  1 , Clemens Becker, Chris Todd, Dietrich Rothenbacher, Claudia Schulz, Hans-Helmut König, Ulrich Liener, Erich Hartwig, Gisela Büchele
Affiliations
Observational Study

The Association Between Orthogeriatric Co-Management and Mortality Following Hip Fracture

Kilian Rapp et al. Dtsch Arztebl Int. .

Abstract

Background: To meet the special needs of older patients with fragility fractures, models for collaborative orthogeriatric care have been developed. The objective of our study was to analyze the association of orthogeriatric co-management with mortality following hip fracture in older patients in Germany.

Methods: This observational study was based on health insurance claims data from 58 001 patients (79.4% women) aged ≥80 years admitted to the hospital with hip fracture between January 2014 and March 2016. They were treated in 828 German hospitals with or without orthogeriatric co-management. The outcome measure was cumulative mortality with adjustment of the regression analyses.

Results: The crude 30-day mortality was 10.3% for patients from hospitals with orthogeriatric co-management and 13.4% for patients from hospitals without orthogeriatric co-management. The adjusted 30-day mortality was 22% lower for patients in hospitals with orthogeriatric co-management (rate ratio 0.78; 95% CI [0.74; 0.82]; adjusted absolute difference -2.48%; 95% CI [-2.98; -1.98]). The difference in 30-day mortality remained nearly unchanged over the first 6 months. The risk reduction with orthogeriatric co-management was consistently observed in both women and men, across age groups, and in patients with and without care needs. The mean length of the index stay was 19.8 days in hospitals with orthogeriatric co-management and 14.4 days in hospitals without orthogeriatric co-management.

Conclusion: A multidisciplinary orthogeriatric approach is associated with lower mortality and a longer index stay in hospital after hip fracture.

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Figures

Figure 1
Figure 1
Flow chart of data management AOK, Allgemeine Ortskrankenkasse; ICD10, International Classification of Diseases, 10th revision; N, total number of participants; n, number of participants in subgroup; OGCM, orthogeriatric co-management
Figure 2
Figure 2
Association of orthogeriatric co-management (OGCM) with mortality (a) and cumulative mortality (b) within 180 days after hospital admission in patients with hip fracture, adjusted for age, sex, care needs in the quarter before the fracture (Q-1), nursing home status in Q-1, number of hip fracture patients per hospital per year, days from hospital admission to surgery, and a medication-based comorbidity score
eFigure 1
eFigure 1
Association of orthogeriatric co-management (OGCM) with cumulative mortality at 30, 60, 90, and 180 days after hospital admission in patients with hip fracture, stratified by sex (a), age (b), care needs (c), and nursing home status (d) Adjusted for age, sex, care needs (yes/no) in the quarter before the fracture (Q-1), nursing home status in Q-1, number of hip fracture patients per hospital per year, days from hospital admission to surgery, and a medication-based comorbidity score
eFigure 2
eFigure 2
Association of orthogeriatric co-management (OGCM) with mortality (a) and cumulative mortality (b) within 180 days after hospital admission in patients with hip fracture aged 65– 79 years Adjusted for age, sex, care needs (yes/no) in the quarter before the fracture (Q-1), nursing home status in Q-1, number of hip fracture patients per hospital per year, days from hospital admission to surgery, and a medication-based comorbidity score
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Comment in

  • Hip Fracture in the Elderly: Time to Act.
    Dreinhöfer K. Dreinhöfer K. Dtsch Arztebl Int. 2020 Jan 24;117(4):51-52. doi: 10.3238/arztebl.2020.0051. Dtsch Arztebl Int. 2020. PMID: 32036853 Free PMC article. No abstract available.

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