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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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| Published in: | Archives of gerontology and geriatrics 2012-09, Vol.55 (2), p.316-322 |
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| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1016/j.archger.2011.11.010 |
| format | article |
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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.</description><identifier>ISSN: 0167-4943</identifier><identifier>EISSN: 1872-6976</identifier><identifier>DOI: 10.1016/j.archger.2011.11.010</identifier><identifier>PMID: 22178013</identifier><language>eng</language><publisher>Netherlands: Elsevier Ireland Ltd</publisher><subject>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</subject><ispartof>Archives of gerontology and geriatrics, 2012-09, Vol.55 (2), p.316-322</ispartof><rights>Elsevier Ireland Ltd</rights><rights>2011 Elsevier Ireland Ltd</rights><rights>Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c519t-798f4506479d9ddd2a93b22c40884fd0cc31ce5a88ce9920d73f456addcb4ddb3</citedby><cites>FETCH-LOGICAL-c519t-798f4506479d9ddd2a93b22c40884fd0cc31ce5a88ce9920d73f456addcb4ddb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958,31035</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22178013$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pioli, Giulio</creatorcontrib><creatorcontrib>Frondini, Carlo</creatorcontrib><creatorcontrib>Lauretani, Fulvio</creatorcontrib><creatorcontrib>Davoli, Maria Luisa</creatorcontrib><creatorcontrib>Pellicciotti, Francesca</creatorcontrib><creatorcontrib>Martini, Emilio</creatorcontrib><creatorcontrib>Zagatti, Anna</creatorcontrib><creatorcontrib>Giordano, Antonio</creatorcontrib><creatorcontrib>Pedriali, Ilaria</creatorcontrib><creatorcontrib>Nardelli, Anna</creatorcontrib><creatorcontrib>Zurlo, Amedeo</creatorcontrib><creatorcontrib>Ferrari, Alberto</creatorcontrib><creatorcontrib>Lunardelli, Maria Lia</creatorcontrib><title>Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units</title><title>Archives of gerontology and geriatrics</title><addtitle>Arch Gerontol Geriatr</addtitle><description>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.</description><subject>Activities of Daily Living</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cognitive ability</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fractures</subject><subject>Functional status</subject><subject>Hip fracture</subject><subject>Hip Fractures - mortality</subject><subject>Hip Fractures - rehabilitation</subject><subject>Hip Fractures - surgery</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Maintenance</subject><subject>Male</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Orthogeriatric unit</subject><subject>Orthopedic Procedures - methods</subject><subject>Orthopedic Procedures - rehabilitation</subject><subject>Prospective Studies</subject><subject>Recovery</subject><subject>Recovery of Function</subject><subject>Rehabilitation</subject><subject>Resources</subject><subject>Surgery</subject><subject>Tertiary Care Centers - statistics & numerical data</subject><subject>Time-to-Treatment</subject><subject>Treatment Outcome</subject><subject>Walking - statistics & numerical data</subject><issn>0167-4943</issn><issn>1872-6976</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>7QJ</sourceid><recordid>eNqNkk2LFDEQhoO4uOPqT1D66KXHykfn46LIsqvCgocdzyGdpJ2M3Z01SQvz700zowcvu1AQAk-9BfUUQm8wbDFg_v6wNcnuf_i0JYDxthZgeIY2WArSciX4c7SpnGiZYvQSvcz5AAAMCH-BLgnBQgKmG7Tbhck3JTZ5STXs2JjZNcnvTR_GUEwJca7fHJdkfW7MMHhbmrgUG6f6D3MTU9nH2hlMScE2yxxKfoUuBjNm__r8XqHvtze76y_t3bfPX68_3bW2w6q0QsmBdcCZUE4554hRtCfEMpCSDQ6spdj6zkhpvVIEnKCV58Y52zPnenqF3p1yH1L8tfhc9BSy9eNoZh-XrHHHsBJCYvUUFAhdt_I4ClytsfwpKKWso9DRinYn1KaYc_KDfkhhMulYIb0a1Qd9NqpXo7pWNVr73p5HLP3k3b-uvwor8PEE-Lrp36G2Zxv8bL0LqcrSLoZHR3z4L8GOYQ7WjD_90edDlT9XjRrrTDTo-_Ws1qvCGIASLukfqojJBw</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Pioli, Giulio</creator><creator>Frondini, Carlo</creator><creator>Lauretani, Fulvio</creator><creator>Davoli, Maria Luisa</creator><creator>Pellicciotti, Francesca</creator><creator>Martini, Emilio</creator><creator>Zagatti, Anna</creator><creator>Giordano, Antonio</creator><creator>Pedriali, Ilaria</creator><creator>Nardelli, Anna</creator><creator>Zurlo, Amedeo</creator><creator>Ferrari, Alberto</creator><creator>Lunardelli, Maria Lia</creator><general>Elsevier Ireland Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>7QJ</scope></search><sort><creationdate>20120901</creationdate><title>Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c519t-798f4506479d9ddd2a93b22c40884fd0cc31ce5a88ce9920d73f456addcb4ddb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Activities of Daily Living</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cognitive ability</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fractures</topic><topic>Functional status</topic><topic>Hip fracture</topic><topic>Hip Fractures - mortality</topic><topic>Hip Fractures - rehabilitation</topic><topic>Hip Fractures - surgery</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Maintenance</topic><topic>Male</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Orthogeriatric unit</topic><topic>Orthopedic Procedures - methods</topic><topic>Orthopedic Procedures - rehabilitation</topic><topic>Prospective Studies</topic><topic>Recovery</topic><topic>Recovery of Function</topic><topic>Rehabilitation</topic><topic>Resources</topic><topic>Surgery</topic><topic>Tertiary Care Centers - statistics & numerical data</topic><topic>Time-to-Treatment</topic><topic>Treatment Outcome</topic><topic>Walking - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pioli, Giulio</creatorcontrib><creatorcontrib>Frondini, Carlo</creatorcontrib><creatorcontrib>Lauretani, Fulvio</creatorcontrib><creatorcontrib>Davoli, Maria Luisa</creatorcontrib><creatorcontrib>Pellicciotti, Francesca</creatorcontrib><creatorcontrib>Martini, Emilio</creatorcontrib><creatorcontrib>Zagatti, Anna</creatorcontrib><creatorcontrib>Giordano, Antonio</creatorcontrib><creatorcontrib>Pedriali, Ilaria</creatorcontrib><creatorcontrib>Nardelli, Anna</creatorcontrib><creatorcontrib>Zurlo, Amedeo</creatorcontrib><creatorcontrib>Ferrari, Alberto</creatorcontrib><creatorcontrib>Lunardelli, Maria Lia</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><jtitle>Archives of gerontology and geriatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pioli, Giulio</au><au>Frondini, Carlo</au><au>Lauretani, Fulvio</au><au>Davoli, Maria Luisa</au><au>Pellicciotti, Francesca</au><au>Martini, Emilio</au><au>Zagatti, Anna</au><au>Giordano, Antonio</au><au>Pedriali, Ilaria</au><au>Nardelli, Anna</au><au>Zurlo, Amedeo</au><au>Ferrari, Alberto</au><au>Lunardelli, Maria Lia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units</atitle><jtitle>Archives of gerontology and geriatrics</jtitle><addtitle>Arch Gerontol Geriatr</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>55</volume><issue>2</issue><spage>316</spage><epage>322</epage><pages>316-322</pages><issn>0167-4943</issn><eissn>1872-6976</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><notes>ObjectType-Article-2</notes><notes>ObjectType-Feature-1</notes><abstract>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.</abstract><cop>Netherlands</cop><pub>Elsevier Ireland Ltd</pub><pmid>22178013</pmid><doi>10.1016/j.archger.2011.11.010</doi><tpages>7</tpages></addata></record> |
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| 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 |
| title | Time to surgery and rehabilitation resources affect outcomes in orthogeriatric units |
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