title: Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Hip fractures are common, morbid, and costly health events that threaten independence and function of older patients. The purpose of this systematic review and meta-analysis was to determine if orthogeriatric collaboration models improve outcomes.
  
  
  METHODS
  Articles in English and Spanish languages were searched in the electronic databases including MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and the Cochrane Registry from 1992 to 2012.
  
  
  METHODS
  Studies were included if they described an inpatient multidisciplinary approach to hip fracture management involving an orthopaedic surgeon and a geriatrician. Studies were grouped into 3 following categories: routine geriatric consultation, geriatric ward with orthopaedic consultation, and shared care. After independent review of 1480 citations by 2 authors, 18 studies (9094 patients) were identified as meeting the inclusion criteria.
  
  
  METHODS
  In-hospital mortality, length of stay, and long-term mortality outcomes were collected.
  
  
  RESULTS
  A random effects model meta-analysis determined whether orthogeriatric collaboration was associated with improved outcomes. The overall meta-analysis found that orthogeriatric collaboration was associated with a significant reduction of in-hospital mortality [relative risk 0.60; 95% confidence interval (95% CI), 0.43-0.84) and long-term mortality (relative risk 0.83; 95% CI, 0.74-0.94). Length of stay (standardized mean difference -0.25; 95% CI, -0.44 to -0.05) was significantly reduced, particularly in the shared care model (standardized mean difference -0.61; 95% CI, -0.95 to -0.28), but heterogeneity limited this interpretation. Other variables such as time to surgery, delirium, and functional status were measured infrequently.
  
  
  CONCLUSIONS
  This meta-analysis supports orthogeriatric collaboration to improve mortality after hip repair. Further study is needed to determine the best model of orthogeriatric collaboration and if these partnerships improve functional outcomes.
authors.affiliation: *University of Cincinnati College of Medicine, Cincinnati, OH; †Division of Aging, Brigham and Women's Hospital, Boston, MA; and ‡Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA.
authors.forename: Konstantin V
authors.initials: KV
authors.lastname: Grigoryan
authors.forename: Houman
authors.initials: H
authors.lastname: Javedan
authors.forename: James L
authors.initials: JL
authors.lastname: Rudolph
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008954:Models, Biological; D016896:Treatment Outcome
references.citation: J Surg Orthop Adv. 2005 Spring;14(1):27-31
references.pmid: 15766439
references.citation: BMJ. 1993 Nov 13;307(6914):1248-50
references.pmid: 8166806
references.citation: Osteoporos Int. 1997;7(5):407-13
references.pmid: 9425497
references.citation: J Am Geriatr Soc. 2002 Oct;50(10):1644-50
references.pmid: 12366617
references.citation: Arch Intern Med. 2009 Oct 12;169(18):1712-7
references.pmid: 19822829
references.citation: J Am Geriatr Soc. 2000 Jun;48(6):618-24
references.pmid: 10855596
references.citation: J Trauma. 2011 Nov;71(5):1390-4
references.pmid: 22002614
references.citation: Am J Med. 1997 Aug 18;103(2A):12S-17S; discussion 17S-19S
references.pmid: 9302893
references.citation: J Inj Violence Res. 2012 Jul;4(2):45-51
references.pmid: 21502786
references.citation: Hip Int. 2010 Apr-Jun;20(2):229-35
references.pmid: 20544649
references.citation: Osteoporos Int. 2010 Dec;21(Suppl 4):S637-46
references.pmid: 21058004
references.citation: CMAJ. 2002 Jul 9;167(1):25-32
references.pmid: 12137074
references.citation: Ann R Coll Surg Engl. 2002 Mar;84(2):122-4
references.pmid: 11995752
references.citation: J Am Geriatr Soc. 2009 Jan;57(1):159-67
references.pmid: 19054192
references.citation: J Am Geriatr Soc. 2001 May;49(5):516-22
references.pmid: 11380742
references.citation: N Engl J Med. 1996 Jun 6;334(23):1519-25
references.pmid: 8618608
references.citation: J Am Med Dir Assoc. 2011 Jul;12(6):439-44
references.pmid: 21450210
references.citation: J Gerontol A Biol Sci Med Sci. 2008 Jan;63(1):92-7
references.pmid: 18245766
references.citation: Arch Orthop Trauma Surg. 2014 Feb;134(2):181-7
references.pmid: 22854843
references.citation: J Rehabil Med. 2007 Apr;39(3):232-8
references.pmid: 17468792
references.citation: J Am Geriatr Soc. 2012 Apr;60(4):733-9
references.pmid: 22429099
references.citation: J Am Geriatr Soc. 2011 Jul;59(7):1299-308
references.pmid: 21718273
references.citation: Eur J Phys Rehabil Med. 2011 Jun;47(2):281-96
references.pmid: 21555985
references.citation: Aging (Milano). 1993 Jun;5(3):207-16
references.pmid: 8399466
references.citation: Med J Aust. 1998 Nov 16;169(10):515-8
references.pmid: 9861907
references.citation: J Orthop Trauma. 2006 Mar;20(3):172-8; discussion 179-80
references.pmid: 16648698
references.citation: J Gerontol A Biol Sci Med Sci. 2000 Sep;55(9):M498-507
references.pmid: 10995047
references.citation: J Am Geriatr Soc. 2005 Sep;53(9):1476-82
references.pmid: 16137275
references.citation: Ir J Med Sci. 2010 Mar;179(1):51-5
references.pmid: 19565316