Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

Antonio De Vincentis¹, Astrid Ursula Behr², Giuseppe Bellelli^{3

4}, Marco Bravi⁵, Anna Castaldo⁶, Lucia Galluzzo⁷, Giovanni Iolascon⁸, Stefania Maggi⁹, Emilio Martini¹⁰, Alberto Momoli¹¹, Graziano Onder⁷, Marco Paoletta⁸, Luca Pietrogrande¹², Mauro Roselli¹³, Mauro Ruggeri¹⁴, Carmelinda Ruggiero¹⁵, Fabio Santacaterina⁵, Luigi Tritapepe¹⁶, Amedeo Zurlo¹⁷, Raffaele Antonelli Incalzi¹⁸; Società Italiana Geriatria e Gerontologia (SIGG),; Associazione Italiana di Psicogeriatria (AIP),; Società Italiana di Geriatria Ospedale e Territorio (SIGOT),; Società Italiana di Medicina Generale (SIMG),; Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI),; Società Italiana di Ortopedia e Traumatologia (SIOT),; Fragility Fracture Network-Italia (FFN-I),; Società Italiana di Medicina Fisica e Riabilitativa (SIMFER),; Società Italiana di Fisioterapia (SIF),; Consiglio Nazionale delle Ricerche (CNR),; Associazione Italiana di Fisioterapia (AIFI),; Istituto Superiore Sanità (ISS)

Affiliations

¹ Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, 00128, Rome, Italy.
² Operative Unit of Anesthesia and Resuscitation, Hospital of Camposampiero, Padua, Italy.
³ Acute Geriatric and Orthogeriatric Unit, S. Gerardo Hospital, Monza, Italy.
⁴ Milano-Bicocca University, Milan, Italy.
⁵ Physical and Rehabilitation Medicine Department, Campus Bio-Medico University of Rome, Rome, Italy.
⁶ Bachelor of Nursing, IRCCS SMN Fondazione Don Gnocchi, University of Milan, Milano, Italy.
⁷ Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy.
⁸ Department of Medical and Surgical Specialties and Dentistry, University of Campania 'Luigi Vanvitelli', Naples, Italy.
⁹ Institute of Neuroscience, Aging Branch, CNR, Padua, Italy.
¹⁰ Orthogeriatric Unit, Azienda Ospedaliero Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
¹¹ Orthopedic and Traumatology Unit, San Bortolo Hospital, Vicenza, Italy.
¹² Orthopedy and Traumatology, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan Medical School, Milan, Italy.
¹³ Orthopedic and Traumatology Unit, 'Maria Vittoria' Hospital, Torino, Italy.
¹⁴ Società Italiana di Medicina Generale (SIMG), Firenze, Italy.
¹⁵ Orthogeriatric Unit, Geriatric Unit, Section of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia, Italy.
¹⁶ Operative Unit of Anesthesia and Intensive Care Medicine, San Camillo-Forlanini Hospital, Rome, Italy.
¹⁷ Geriatric and Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy.
¹⁸ Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, 00128, Rome, Italy. r.antonelli@unicampus.it.

PMID: 34287785
DOI: 10.1007/s40520-021-01898-9

Review

Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

Antonio De Vincentis et al. Aging Clin Exp Res. 2021 Sep.

. 2021 Sep;33(9):2405-2443.

doi: 10.1007/s40520-021-01898-9. Epub 2021 Jul 21.

Authors

Affiliations

¹ Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, 00128, Rome, Italy.
² Operative Unit of Anesthesia and Resuscitation, Hospital of Camposampiero, Padua, Italy.
³ Acute Geriatric and Orthogeriatric Unit, S. Gerardo Hospital, Monza, Italy.
⁴ Milano-Bicocca University, Milan, Italy.
⁵ Physical and Rehabilitation Medicine Department, Campus Bio-Medico University of Rome, Rome, Italy.
⁶ Bachelor of Nursing, IRCCS SMN Fondazione Don Gnocchi, University of Milan, Milano, Italy.
⁷ Department of Cardiovascular, Endocrine-Metabolic Diseases and Ageing, Istituto Superiore di Sanità, Rome, Italy.
⁸ Department of Medical and Surgical Specialties and Dentistry, University of Campania 'Luigi Vanvitelli', Naples, Italy.
⁹ Institute of Neuroscience, Aging Branch, CNR, Padua, Italy.
¹⁰ Orthogeriatric Unit, Azienda Ospedaliero Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
¹¹ Orthopedic and Traumatology Unit, San Bortolo Hospital, Vicenza, Italy.
¹² Orthopedy and Traumatology, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan Medical School, Milan, Italy.
¹³ Orthopedic and Traumatology Unit, 'Maria Vittoria' Hospital, Torino, Italy.
¹⁴ Società Italiana di Medicina Generale (SIMG), Firenze, Italy.
¹⁵ Orthogeriatric Unit, Geriatric Unit, Section of Gerontology and Geriatrics, Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, S. Andrea delle Fratte, Perugia, Italy.
¹⁶ Operative Unit of Anesthesia and Intensive Care Medicine, San Camillo-Forlanini Hospital, Rome, Italy.
¹⁷ Geriatric and Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy.
¹⁸ Unit of Internal Medicine and Geriatrics, Università Campus Bio-Medico di Roma, 00128, Rome, Italy. r.antonelli@unicampus.it.

PMID: 34287785
DOI: 10.1007/s40520-021-01898-9

Abstract

Background: Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues.

Aim: To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF.

Methods: A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence.

Results: A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics).

Conclusion: These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.

Keywords: Consensus; Femur fracture; Hip fracture; Older; Orthogeriatric management.

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References

1. Programma Nazionale Esiti (PNE) (2020) Home. https://pne.agenas.it/index.php?lang=IT . Accessed 10 Apr 2021
1. Haentjens P, Magaziner J, Colón-Emeric CS et al (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390. https://doi.org/10.7326/0003-4819-152-6-201003160-00008 - DOI - PubMed - PMC
1. Maggi S, Siviero P, Wetle T et al (2010) A multicenter survey on profile of care for hip fracture: predictors of mortality and disability. Osteoporos Int 21:223–231. https://doi.org/10.1007/s00198-009-0936-8 - DOI - PubMed
1. Grigoryan KV, Javedan H, Rudolph JL (2014) Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma 28:e49-55. https://doi.org/10.1097/BOT.0b013e3182a5a045 - DOI - PubMed - PMC
1. Mukherjee K, Brooks SE, Barraco RD et al (2020) Elderly adults with isolated hip fractures—orthogeriatric care versus standard care: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 88:266–278. https://doi.org/10.1097/TA.0000000000002482 - DOI - PubMed

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Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

Affiliations

Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus

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