Postoperative admission to a dedicated geriatric unit decreases mortality in elderly patients with hip fracture.
BACKGROUND
Elderly patients with hip fracture have a 5 to 8 fold increased risk of death during the months following surgery. We tested the hypothesis that early geriatric management of these patients focused on co-morbidities and rehabilitation improved long term mortality.


RESULTS
In a cohort study over a 6 year period, we compared patients aged >70 years with hip fracture admitted to orthopedic versus geriatric departments in a time series analysis corresponding to the creation of a dedicated geriatric unit. Co-morbidities were assessed using the Cumulative Illness Rating Scale (CIRS). Each cohort was compared to matched cohorts extracted from a national registry (n = 51,275) to validate the observed results. Main outcome measure was 6-month mortality. We included 131 patients in the orthopedic cohort and 203 in the geriatric cohort. Co-morbidities were more frequent in the geriatric cohort (median CIRS: 8 vs 5, P<0.001). In the geriatric cohort, the proportion of patients who never walked again decreased (6% versus 22%, P<0.001). At 6 months, re-admission (14% versus 29%, P = 0.007) and mortality (15% versus 24%, P = 0.04) were decreased. When co-morbidities were taken into account, the risk ratio of death at 6 months was reduced (0.43, 95%CI 0.25 to 0.73, P = 0.002). Using matched cohorts, the average treatment effects on the treated associated to early geriatric management indicated a reduction in hospital mortality (-63%; 95% CI: -92% to -6%, P = 0.006).


CONCLUSIONS
Early admission to a dedicated geriatric unit improved 6-month mortality and morbidity in elderly patients with hip fracture.
Université Pierre et Marie Curie (UMRS 956, UMRS 1158), Paris, France ; Department of Geriatrics, Groupe hospitalier (GH) Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.
Jacques
J
Boddaert
Université Pierre et Marie Curie (UMRS 956, UMRS 1158), Paris, France.
Judith
J
Cohen-Bittan
Department of Orthopedic Surgery and Trauma, GH Pitié-Salpêtrière, APHP, Paris, France.
Frédéric
F
Khiami
Departments of Anesthesia & Clinical Epidemiology and Biostatistics, Michael DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Yannick
Y
Le Manach
Université Pierre et Marie Curie (UMRS 956, UMRS 1158), Paris, France ; Department of Anesthesiology and Critical Care, GH Pitié-Salpêtrière, APHP, Paris, France ; Institut national de la santé et de la recherche médicale (UMRS 956, UMRS 1158, UMR 689), Paris, France.
Mathieu
M
Raux
Department of Rehabilitation, Groupe Hospitalier Charles Foix, APHP, Ivry-sur-Seine, France.
Jean-Yves
JY
Beinis
Université Pierre et Marie Curie (UMRS 956, UMRS 1158), Paris, France ; Department of Geriatrics, Groupe hospitalier (GH) Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris (APHP), Paris, France.
Marc
M
Verny
Université Pierre et Marie Curie (UMRS 956, UMRS 1158), Paris, France ; Department of Emergency Medicine and Surgery, GH Pitié-Salpêtrière, APHP, Paris, France ; Institut national de la santé et de la recherche médicale (UMRS 956, UMRS 1158, UMR 689), Paris, France.
Bruno
B
Riou
D000368:Aged; D015331:Cohort Studies; D006620:Hip Fractures / Q000401:mortality*; D006757:Hospital Units; D006801:Humans; D010343:Patient Admission; D011184:Postoperative Period