Outcomes for older patients with hip fractures: The impact of orthopedic and geriatric medicine cocare

Objectives: To assess the impact of a specifically designed model of orthopedic-geriatric cocare oil hip fracture (H F) outcomes. Setting: Tertiary teaching hospital (level I trauma center). Design: prospective observational study with I retrospective (historical) control. Data oil 951 Consecutive patients 60 years of age or older admitted to the authors institution Wit nonpathologic HF over a 7-year period (1995 to 2002) were analyzed. Between 1995 and 1997, medical problems were managed by I geriatric medicine (GM) consultation-only service (retrospective audit). In 1998, a GM registrar began overseeing daily medical care with weekly geriatrician consultant review (prospective Study). Outcomes for 2 time periods were compared: a 3-year period before (no GM; 504 patients) and a 4-year period after (GM; 447 patients) the introduction of GM cocare. Main Outcome Measurements: Postoperative medical complications, mortality, length of stay, discharge destination, use of thromboprophylaxis, and antiosteoporotic treatment. Results: While comparing 2 periods (GM and no GM), significant reductions ill postoperative medical complications and comorbid conditions (in total 49.5% vs. 71.0%, P < 0.001) and mortality (4.7% vs. 7.7%, P < 0.01) Occurred and rehospitalization to medical wards Within 6 months decreased (28% vs. 7.6%). However, no differences were observed in median length of hospital stay (10.8 vs. 11.0 days) or in discharge destination. Antiosteoporotic treatment (12% to 69%) and specific thromboprophylaxis (63% to 94%) increased in the GM period. Conclusions: Orthopcdic-geriatric cocare for the older patients with HF was associated with significant reductions in morbidity and mortality, and increases in optimal postoperative care. Options for further improvement of orthopedic-GM cocare need to be investigated.