title: Orthogeriatric co-management improves the outcome of long-term care residents with fragility fractures.
abstract: BACKGROUND
  Fragility fractures are a major health care problem worldwide. Both hip and non-hip fractures are associated with excess mortality in the years following the fracture. Residents of long-term nursing homes represent a special high-risk group for poor outcomes. Orthogeriatric co-management models of care have shown in multiple studies to have medical as well as economic advantages, but their impact on this high-risk group has not been well studied.
  
  
  OBJECTIVE
  We studied the outcome of long-term care residents with hip and non-hip fractures admitted to a geriatric fracture center.
  
  
  METHODS
  The study design is a single center, prospective cohort study at a level-I trauma center in Austria running a geriatric fracture center. The cohort included all fragility fracture patients aged over 70 admitted from a long-term care residence from May 2009 to November 2011. The data set consisted of 265 patients; the mean age was 86.8 ± 6.7 years, and 80 % were female. The mean follow-up after the index fracture was 789 days, with a range from 1 to 1842 days. Basic clinical and demographic data were collected at hospital admission. Functional status and mobility were assessed during follow-up at 3, 6, and 12 months. Additional outcome data regarding readmissions for new fractures were obtained from the hospital information database; mortality was crosschecked with the death registry from the governmental institute of epidemiology.
  
  
  RESULTS
  187 (70.6 %) patients died during the follow-up period, with 78 patients (29.4 %) dying in the first year. The mean life expectancy after the index fracture was 527 (±431) days. Differences in mortality rates between hip and non-hip fracture patients were not statistically significant. Compared to reported mortality rates in the literature, hip fracture patients in this orthogeriatric-comanaged cohort had a significantly reduced one-year mortality [OR of 0.57 (95 % CI 0.31-0.85)]. After adjustment for confounders, only older age (OR 1.091; p = 0.013; CI 1.019-1.169) and a lower Parker Mobility Scale (PMS) (OR 0.737; p = 0.022; CI 0.568-0.957) remained as independent predictors. During follow-up, 62 patients (23.4 %) sustained at least one subsequent fracture, and 10 patients (3.4 %) experienced multiple fractures; 29 patients (10.9 %) experienced an additional fracture within the first year. Nearly, half (47.1 %) regained their pre-fracture mobility based on the PMS.
  
  
  CONCLUSIONS
  Despite the generally poor outcomes for fragility fracture patients residing in long-term care facilities, orthogeriatric co-management appears to improve the outcome of high-risk fragility fracture patients. One-year mortality was 29.4 % in this cohort, significantly lower than in comparable trials. Orthogeriatric co-management may also have positive impacts on both functional outcome and the risk of subsequent fractures.
authors: Department of Geriatrics, Paracelsus Medical Private University Nuremberg, Hospital Nuremberg, 90408, Nuremburg, Germany. markus.gosch@klinikum-nuernberg.de.
authors: M
authors: http://orcid.org/0000-0001-7720-2506
authors: M
authors: Gosch
authors: Department of Internal Medicine I, Gastroenterology, Endocrinology and Metabolism, Medical University of Innsbruck, Innsbruck, Austria.
authors: Y
authors: Y
authors: Hoffmann-Weltin
authors: Department of Trauma Surgery and Sports Medicine, Medical University of Innsbruck, Innsbruck, Austria.
authors: T
authors: T
authors: Roth
authors: Department of Trauma Surgery and Sports Medicine, Medical University of Innsbruck, Innsbruck, Austria.
authors: M
authors: M
authors: Blauth
authors: Rochester, Division of Geriatrics, University of Rochester Medical Center, Rochester, NY, USA.
authors: J A
authors: JA
authors: Nicholas
authors: Department of Trauma Surgery and Sports Medicine, Medical University of Innsbruck, Innsbruck, Austria.|Department for Trauma-, Hand- and Plastic Surgery, LMU Munich, Munich, Germany.
authors: C
authors: C
authors: Kammerlander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001317:Austria; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000458:organization & administration*; D006620:Hip Fractures / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009985:Orthopedics; D058866:Osteoporotic Fractures / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D014193:Trauma Centers / Q000458:organization & administration*; D016896:Treatment Outcome
keywords: Fragility fracture; Hip fracture; Long-term care patients; Orthogeriatric co-management; Outcome