title: Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment.
abstract: OBJECTIVE
  To compare survival rates of hip fracture patients treated within a comprehensive geriatric hip fracture unit (CGHFU) with those undergoing a standard of care treatment (SOCT) in general orthopedic wards.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  A geriatric hip fracture unit of a division of geriatric medicine and rehabilitation and departments of general orthopedic surgery of a tertiary hospital.
  
  
  METHODS
  Participants were 3114 consecutive hip fracture patients: 847 were admitted to CGHFU and 2267 to wards of general orthopedics.
  
  
  METHODS
  Surgical repair followed by standard rehabilitation course
  
  
  METHODS
  Mortality rates at 30 days, 90 days, and 1 year.
  
  
  RESULTS
  CGHFU population was older (P < .0001), comprised more women (P < .0001), and suffered a greater number of comorbidities (P < .0001). Crude 30-day mortality rates were 1.9% and 3.0% for CGHFU and SOCT, respectively. At 90 days, crude rates were 6.5% and 8.1%, respectively, and 14.8% and 17.3%, at 1 year, respectively. Cox proportional hazard models adjusted for sociodemographics, Comorbidity, and surgery characteristics showed borderline significant lower mortality hazard ratios for CGHFU in comparison with SOCT, for 1-month and 3-month intervals. The adjusted Cox model favored the CGHFU modality of care with regard to 1-year cumulative mortality (hazard ratios 0.78, 95% confidence interval 0.63-0.96, P = .016). Male gender, age, diabetes, and number of operations were predictive of increased 1-year mortality risk in the separate regression models by gender and age group (<85, 85+).
  
  
  CONCLUSIONS
  Crude and adjusted mortality rates are lower in a geriatric hip fracture unit, as compared with the common standard of care model of general orthopedic wards. Combined with earlier data on improved functional outcomes of CGHFU, these findings further support the implementation of similar comprehensive orthogeriatric models of care.
authors: Department of Geriatric Medicine & Rehabilitation, Sheba Medical Center, Tel - Hashomer, Israel. adunger1@sheba.health.gov.il
authors: Abraham
authors: A
authors: Adunsky
authors: Liat
authors: L
authors: Lerner-Geva
authors: Tzvia
authors: T
authors: Blumstein
authors: Valentina
authors: V
authors: Boyko
authors: Eliyahu
authors: E
authors: Mizrahi
authors: Marina
authors: M
authors: Arad
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D059039:Standard of Care; D016019:Survival Analysis