[Is there Sense in Having a Certified Centre for Geriatric Trauma Surgery?].
BACKGROUND
By 2030, 30 % of German residents will be over 70 years of age. In 2009, we conceptualised a TÜV (German Technical Inspection Authority) certified interdisciplinary centre for geriatric trauma care. All treatment pathways were agreed upon by all disciplines. Complex geriatric therapy was established, and patients were seen by trauma surgeons, geriatricians, therapists, and a pharmacist. Cases were discussed in team meetings. Morbidity and mortality conferences were conducted. In 2014, supplementary DGU (German Society for Trauma Surgery) certification was achieved.


OBJECTIVE
Have these measures led to improved quality of care and have the increased costs been covered? Is the formation of such a centre worthwhile for patients and hospitals?


METHODS
This interdisciplinary treatment was implemented for all patients over 70 admitted with proximal femur, proximal humerus, and vertebral fractures. In 2012, there were 208 proximal femur, 171 vertebral, and 69 humeral fractures. The following parameters were defined for quality control: admission and diagnosis completed within 90 minutes, over 80 % of operations performed within 24 hours, reoperation rate under 12 %, decubitus rate under 5 %, mobilisation within 24 hours of surgery in 75 %, discharge to the previous environment in over 80 % of cases, and minimal mortality rates.


RESULTS
Surgery performed within 24 hours fell just short of target in 2012 with 78 %, and 2013 with 81 %. The target time for diagnosis was reached in only 30 % of patients in 2012 and in 42 % in 2013; thus, more outpatient personnel was added. Mobilisation within 24 hours of surgery was completed in 79 % of patients in 2012. Implementation of decubitus standards reduced the rate of decubitus formation from 8 to 3.2 %. Reoperation rate was 5.2 % in 2012 and 3.1 % in 2013. In 2012, 6.4 % and in 2013, 9.3 % of discharged patients required short- and long-term care facilities for the first time, and the rest were discharged to rehabilitation or directly back home. Mortality rates for proximal femur fractures were 5.7 % in 2010, 5.1 % in 2011, 2.9 % in 2012, and 3.0 % in 2013. The implementation of complex geriatric therapy generated 103 treatments in 2012 with revenue of 912,000 €, and 160 treatments in 2013 with revenue of 1.35 million €.


CONCLUSIONS
Interdisciplinary geriatric-trauma therapy for older patients resulted in improved measurable outcomes. Interdisciplinary geriatric trauma care with implementation of complex therapy benefits both patients and hospitals.
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Kliniken Sindelfingen, Klinikverbund Südwest.
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Prokop
Altersmedizin, Med. VI, Kliniken Sindelfingen.
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KM
Reinauer
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Kliniken Sindelfingen, Klinikverbund Südwest.
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Chmielnicki
D000368:Aged; D000369:Aged, 80 and over; D002568:Certification / Q000592:standards; D005260:Female; D050723:Fractures, Bone / Q000401:mortality* / Q000601:surgery*; D005858:Germany / Q000453:epidemiology; D006299:Health Services for the Aged / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D061646:Operative Time; D019637:Orthopedic Procedures / Q000401:mortality / Q000592:standards; D010348:Patient Care Team / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D015996:Survival Rate; D014194:Traumatology / Q000592:standards; D016896:Treatment Outcome