title: Dedicated orthogeriatric service reduces hip fracture mortality.
abstract: BACKGROUND
  Hip fracture is a common serious injury afflicting the geriatric population and is associated with poor clinical outcomes, functional and walking disabilities and high 1-year mortality rates. A multidisciplinary approach has been shown to improve outcomes of geriatric patients with fragility fracture.
  
  
  OBJECTIVE
  We piloted a dedicated orthogeriatric service for hip fracture patients to determine if the service facilitated a change in major patient outcomes, such as mortality, length of stay and dependency.
  
  
  METHODS
  A dedicated orthogeriatrics service for hip fracture was established as a collaborative project between the Department of Geriatric Medicine and Department of Orthopaedic Surgery at a university teaching hospital. Orthogeriatrics service data were collected prospectively on an orthogeriatric filemaker database from July 2011 to July 2012 (N = 206). Data were compared to previously recorded data (Irish Hip Fracture Database) on a cohort of hip fracture patients admitted to the same orthopaedic trauma unit from July 2009 to July 2010 (N = 248).
  
  
  RESULTS
  Patients in the orthogeriatric service group experienced significant reductions in 1-year mortality (χ2= 13.34, P < 0.001), length of acute hospital stay (U = -3.77, P < 0.001) and requirements for further rehabilitation (χ2= 26.59, P < 0.001). Patients in the pre-service establishment group were significantly more dependent following their fracture than the patients in the orthogeriatric service group (χ2= 5.34, P = 0.021).
  
  
  CONCLUSIONS
  A multidisciplinary management approach to fragility fracture of the femoral neck that involves comprehensive geriatric assessment, daily medical involvement of a geriatric team and specialised follow-up assessment leads to a significant reduction in mortality and improved outcomes.
authors.affiliation: Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
authors.forename: C Y
authors.initials: CY
authors.lastname: Henderson
authors.affiliation: Department of Medicine, Division of Geriatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
authors.forename: E
authors.initials: E
authors.lastname: Shanahan
authors.affiliation: Department of Trauma and Orthopaedics, University Hospital Limerick, Limerick, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Butler
authors.affiliation: Department of Trauma and Orthopaedics, University Hospital Limerick, Limerick, Ireland.
authors.forename: B
authors.initials: B
authors.lastname: Lenehan
authors.affiliation: Department of Medicine, Division of Geriatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: O'Connor
authors.affiliation: Department of Medicine, Division of Geriatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
authors.forename: D
authors.initials: D
authors.lastname: Lyons
authors.affiliation: Department of Medicine, Division of Geriatrics, University Hospital Limerick, Dooradoyle, Limerick, Ireland. juderyan@eircom.net.
authors.forename: J P
authors.initials: JP
authors.lastname: Ryan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003299:Cooperative Behavior; D005260:Female; D005853:Geriatrics / Q000458:organization & administration*; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D009985:Orthopedics / Q000458:organization & administration*; D010865:Pilot Projects; D014193:Trauma Centers
keywords: Comprehensive geriatric assessment; Fragility fracture; Hip fracture; Neck of femur; Orthogeriatric