title: Complications during hospitalization and risk factors in elderly patients with hip fracture following integrated orthogeriatric treatment.
abstract: BACKGROUND
  This study aimed to evaluate the incidence of complications in elderly patients with a hip fracture following integrated orthogeriatric treatment. To discover factors that might be adjusted, in order to improve outcome in those patients, we examined the association between baseline patient characteristics and a complicated course.
  
  
  METHODS
  We included patients aged 70 years and older with a hip fracture, who were treated at the Centre for Geriatric Traumatology (CvGT) at Ziekenhuisgroep Twente (ZGT) Almelo, the Netherlands between April 2011 and October 2013. Data registration was carried out using the clinical pathways of the CvGT database. Based on the American Society of Anesthesiologists (ASA) score, patients were divided into high-risk (HR, ASA 3 ≥, n = 341) and low-risk (LR, ASA 1-2, n = 111) groups and compared on their recovery. Multivariate logistic regression was used to identify risk factors for a complicated course.
  
  
  RESULTS
  The analysis demonstrated that 49.6% (n = 224) of the patients experienced a complicated course with an in-hospital mortality rate of 3.8% (n = 17). In 57.5% (n = 196) of the HR patients, a complicated course was seen compared to 25.2% (n = 28) of the LR patients. The most common complications in both groups were the occurrence of delirium (HR 25.8% vs. LR 8.1%, p ≤ 0.001), anemia (HR 19.4% vs. LR 6.3%, p = 0.001), catheter-associated urinary tract infections (CAUTIs) (HR 10.6% vs. LR 7.2%, p = 0.301) and pneumonia (HR 10.9% vs. LR 5.4%, p = 0.089). Independent risk factors for a complicated course were increasing age (OR 1.04, 95% CI 1.01-1.07, p = 0.023), delirium risk VMS Frailty score (OR 1.57, 95% CI 1.04-2.37, p = 0.031) and ASA score ≥3 (OR 3.62, 95% CI 2.22-5.91, p ≤ 0.001).
  
  
  CONCLUSIONS
  After integrated orthogeriatric treatment, a complicated course was seen in 49.6% of the patients with a hip fracture. The in-hospital mortality rate was 3.8%. Important risk factors for a complicated course were increasing age, poor medical condition and delirium risk VMS Frailty score. Awareness of risk factors that affect the course during admission can be useful in optimizing care and outcomes. In the search for possible areas for improvement in care, targeted preventive measures to mitigate delirium, and healthcare-associated infections (HAIs), such as CAUTIs and pneumonia are important.
authors.affiliation: Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands. e.folbert@zgt.nl.
authors.forename: E C
authors.initials: EC
authors.lastname: Folbert
authors.affiliation: Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Hegeman
authors.affiliation: Department of Finance and Organization, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Gierveld
authors.affiliation: ZGT Academy, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Netten
authors.affiliation: Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo-Hengelo, The Netherlands.
authors.forename: D van der
authors.initials: DV
authors.lastname: Velde
authors.affiliation: Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
authors.forename: H J
authors.initials: HJ
authors.lastname: Ten Duis
authors.affiliation: Department of Geriatric Medicine, University Medical Centre Groningen, Goningen, Leydenacademy on Vitality and Aging, Leiden, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Slaets
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology*; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology*; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D005853:Geriatrics; D006333:Heart Failure / Q000453:epidemiology; D006620:Hip Fractures / Q000601:surgery*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction; D009426:Netherlands / Q000453:epidemiology; D009985:Orthopedics; D010348:Patient Care Team; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology*
keywords: ASA; Adverse outcomes; Hip fracture; Learning healthcare system; Orthogeriatric care; Quality improvement