title: 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.
  
  
  METHODS
  Prospective inception multicenter cohort study.
  
  
  METHODS
  Three tertiary Hospitals.
  
  
  METHODS
  806 patients consecutively admitted with HF.
  
  
  METHODS
  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.
authors.affiliation: Geriatric Unit, Department of Neurological and Mobility Sciences Arcispedale Santa Maria Nuova, Viale Risorgimento 80, Reggio Emilia, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Pioli
authors.forename: Carlo
authors.initials: C
authors.lastname: Frondini
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lauretani
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Davoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Pellicciotti
authors.forename: Emilio
authors.initials: E
authors.lastname: Martini
authors.forename: Anna
authors.initials: A
authors.lastname: Zagatti
authors.forename: Antonio
authors.initials: A
authors.lastname: Giordano
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pedriali
authors.forename: Anna
authors.initials: A
authors.lastname: Nardelli
authors.forename: Amedeo
authors.initials: A
authors.lastname: Zurlo
authors.forename: Alberto
authors.initials: A
authors.lastname: Ferrari
authors.forename: Maria Lia
authors.initials: ML
authors.lastname: Lunardelli
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods / Q000534:rehabilitation; D011446:Prospective Studies; D020127:Recovery of Function; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D061665:Time-to-Treatment; D016896:Treatment Outcome; D016138:Walking / Q000706:statistics & numerical data