Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units

Abstract Objective : To compare the pathways of care and clinical results for patients admitted for hip fracture (HF) in 3 orthogeriatric co-managed care centers in order to estimate the effect of system factors on mortality and functional outcome. Design : Prospective inception multicenter cohort s...

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Bibliographic Details
Published in:Archives of gerontology and geriatrics 2012-09, Vol.55 (2), p.316-322
Main Authors: Pioli, Giulio, Frondini, Carlo, Lauretani, Fulvio, Davoli, Maria Luisa, Pellicciotti, Francesca, Martini, Emilio, Zagatti, Anna, Giordano, Antonio, Pedriali, Ilaria, Nardelli, Anna, Zurlo, Amedeo, Ferrari, Alberto, Lunardelli, Maria Lia
Format: Article
Language:English
Subjects:
Activities of Daily Living
Age
Aged
Aged, 80 and over
Cognitive ability
Cohort Studies
Female
Fractures
Functional status
Hip fracture
Hip Fractures - mortality
Hip Fractures - rehabilitation
Hip Fractures - surgery
Hospitals
Humans
Internal Medicine
Maintenance
Male
Morbidity
Mortality
Orthogeriatric unit
Orthopedic Procedures - methods
Orthopedic Procedures - rehabilitation
Prospective Studies
Recovery
Recovery of Function
Rehabilitation
Resources
Surgery
Tertiary Care Centers - statistics & numerical data
Time-to-Treatment
Treatment Outcome
Walking - statistics & numerical data
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Summary:Abstract Objective : To compare the pathways of care and clinical results for patients admitted for hip fracture (HF) in 3 orthogeriatric co-managed care centers in order to estimate the effect of system factors on mortality and functional outcome. Design : Prospective inception multicenter cohort study. Setting : Three tertiary Hospitals. Participants : 806 patients consecutively admitted with HF. Measurements : 1-Year mortality, the loss of 1 or more functional abilities in activities of daily living (ADLs), and the recovery/maintenance of independent ambulation at 6 months from the fracture. Results : On the whole sample, 71.1% of patients survived 1 year from the fracture. In one hospital the risk of 1-year mortality was significantly higher even after adjusting for age, sex, comorbidity, prefracture functional status and cognitive impairment (odd ratio (OR) 1.56, 95% confidence interval (CI) 1.15–2.18, p = 0.01). This was principally explained by a longer time to surgery (5.2 days ± 3.2 vs 2.7 ± 2.3 and 2.7 ± 2.2, p < 0.001). The three hospitals also differed in the rate of subjects losing the ability in ADLs after 6 months from the fracture (54.2%, 61%, 43.5%, p = 0.016), while no statistical differences were found in the recovery of independent ambulation. On the basis of multivariate models, a lower access to post-acute rehabilitation could account for lower outcome in functional status. Conclusions : This study suggests that system factors such as time to surgery and rehabilitation resources can affect functional recovery and 1-year mortality in orthogeriatric units and they could explain different outcomes when comparing care models.
ISSN:0167-4943
1872-6976
DOI:10.1016/j.archger.2011.11.010