Fractures' associated mortality risk in orthogeriatric inpatients: a prospective 2-year survey

Purpose!#!The most common osteoporotic fragility fractures are hip, vertebral and upper extremity fractures. An association with increased mortality is widely described with their occurrence. Fracture-specific associated death rates were determined in a 2-year follow-up for patients treated on an orthogeriatric ward. These were compared amongst each other, examined for changes with age and their impact on the relative mortality risk in relation to the corresponding population.!##!Methods!#!We assessed all patients that were treated in the course of a year on an orthogeriatric ward and suffered from the following injuries: hip (HF), vertebral (VF) and upper extremity fractures (UEF). In a 2-year follow-up it was possible to determine the month of death in the case of the patient's decease. Pairwise comparisons of the three fracture type death rates were performed through Cox-Regression. We stratified the fracture-dependent absolute mortality and age-specific mortality risk (ASMR) for age groups 71-80, 81-90 and 91-95.!##!Results!#!Overall, we assessed 240 patients with HF, 96 with VF and 127 with UEF over the span of a year. 1- and 2-year-mortality was: HF: 29.6% a.e. 42.9%, VF: 29.2% a.e. 36.5%, UEF: 20.5% a.e 34.6%. Pairwise comparisons of these mortality values revealed no significant differences. In association with HF and VF, we observed a significant increase of 2-year mortality for the oldest compared to the youngest patients (HF: 60.4% vs. 22.5%; p = 0.028) (VF 70% vs. 14.3%; p = 0.033). The analogue comparison for UEF revealed no relevant difference in age-dependent mortality (40.9% vs. 31.1%; p = 0.784). Common for all fracture types ASMR's were more elevated in the younger patients and decreased with higher age.!##!Conclusion!#!The fracture-related mortality in the 2-year follow-up was comparable. We observed a reduction of relative mortality risk in the oldest patients. While a direct influence of fracture on mortality must be supposed, we support the thesis of the fracture rather being an indicator of higher susceptibility of timely death

Early surgery? In-house mortality after proximal femoral fractures does not increase for surgery up to 48 h after admission

Purpose The economic cost linked to the increasing number of proximal femur fracture and their postoperative care is immense. Mortality rates are high. As early surgery is propagated to lower mortality and reduce complication rates, a 24-h target for surgery is requested. It was our aim to determine the cut-off for the time to surgery from admission and therefore establish a threshold at which the in-house mortality rate changes. Methods A retrospective single-center cohort study was conducted including 1796 patients with an average age of 82.03 years treated operatively for a proximal femoral fracture between January 2016 and June 2020. A single treatment protocol was performed based on the type of anticoagulant, surgery, and renal function. Patient data, surgical procedure, time to surgery, complications, and mortality were assessed. Results In-house mortality rate was 3.95%, and the overall complication rate was 22.7%. A prolonged length of hospital stay was linked to patient age and occurrence of complications. Mortality is influenced by age, number of comorbidities BMI, and postoperative complications of which the most relevant is pneumonia. The mean time to surgery for the entire cohort was 26.4 h. The investigation showed no significant difference in mortality rate among the two groups treated within 24 h and 24 to 48 h while comparing all patients treated within 48 h and after 48 h revealed a significant difference in mortality. Conclusions Age and number of comorbidities significantly influence mortality rates. Time to surgery is not the main factor influencing outcome after proximal femur fractures, and mortality rates do not differ for surgery up to 48 h after admission. Our data suggest that a 24-h target is not necessary, and the first 48 h may be used for optimizing preoperative patient status if necessary

Orthogeriatric co-management: differences in outcome between major and minor fractures

PURPOSE: Literature shows that orthogeriatric co-management improves the outcomes of patients with hip fractures. Corresponding research with more diverse fragility fracture groups is lacking. Therefore, an examination was performed prospectively as a 2 year-follow-up on an orthogeriatric co-managed ward, comparing relevant outcome parameters for major and minor fragility fractures. METHODS: All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included and their injuries, orthogeriatric parameters such as the Barthel Index (BI), Parker Mobility Score (PMS) and place of residence (POR). Patients were separated into two groups of either immobilizing major (MaF) or non-immobilizing minor (MiF) fractures. 2 years later, a follow-up was conducted via telephone calls and questionnaires mailed to patients and/or their relatives. RESULTS: 740 (574 major vs. 166 minor injuries) patients were initially assessed, with a follow-up rate of 78.9%. The in-house, 1-year, and 2-year-mortality rates were 2.7, 27.4, and 39.2%, respectively. Mortality was significantly higher for MaF in the short term, but not after 2 years. On average, during the observation period, patients regained their BI by 36.7 points (95% CI: 33.80–39.63) and PMS was reduced by 1.4 points (95% CI: 1.16–1.68). No significant differences were found in the readmission rate, change in BI, PMS or POR between the MaF and MiF groups. CONCLUSION: The relevance of orthogeriatric treatment to improving functional and socioeconomic outcomes was confirmed. The similarity of the results from both fracture groups emphasizes the need for a multidisciplinary approach also for minor fractures. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00068-022-01974-3

Die proximale Humerusfraktur: ist die Operation immer die beste Wahl

Hintergrund Proximale Humerusfrakturen gehören zu den dritthäufigsten, osteoporotischen Verletzungen mit steigender Inzidenz. Die Indikationsstellung wird weiterhin kontrovers diskutiert. Ziel unserer Studie war es herauszufinden, ob der Trend zur konservativen Therapie gerechtfertigt ist und sich hiermit v. a. beim geriatrischen Patienten vergleichbare, reproduzierbare Ergebnisse erreichen lassen. Material und Methoden In die retrospektive Single-center-Studie wurden 128 Patienten mit konservativer und kopferhaltender operativer Therapie zwischen 2013 und 2015 eingeschlossen und davon wurden 91 nachuntersucht. Demografische Daten, operative Versorgung sowie Komplikationen wurden erhoben. Eine Follow-up-Untersuchung fand statt, in der Subjective Shoulder Value (SSV), visuelle Analogskala (VAS), Disability of Arm, Shoulder and Hand Questionnaire (DASH), Constant Murley Score (CMS) und Bewegungsausmaß erhoben wurden. Eine radiologische Auswertung wurde durchgeführt. Ergebnisse In den Scores wurden folgende Ergebnisse für konservative und operative Therapie erzielt (konservativ: VAS Schmerz 8,9 Punkte, CMS abs. 70,7 Punkte, DASH: 16,5 Punkte; operativ: VAS Schmerz 1,7 Punkte, CMS abs. 63,5 Punkte, DASH: 24,2 Punkte). Es zeigte sich kein signifikanter Unterschied zwischen Nagel- und Plattenosteosynthese. Die Komplikationsrate betrug 20 %. Die konservative Gruppe erzielte ein besseres Bewegungsausmaß. Die dislozierten Frakturen waren auffallend, wenngleich nicht statistisch signifikant schlechter im Vergleich zu den Neer-1-Frakturen und nur leichtgradig schlechter als die operativ versorgten Patienten. Schlussfolgerung Die Behandlung der proximalen Humerusfraktur bleibt weiterhin eine individuelle Entscheidung abhängig von Funktionsanspruch, Alter und Komorbiditäten. Die konservative Therapie kann in Erwägung gezogen werden, teils auch bei formell bestehender Operationsindikation (v. a. 2‑ und 3‑Part-Frakturen), da sich hiermit vergleichbare Langzeitergebnisse mit hoher Patientenzufriedenheit und reduziertem (perioperativem) Risiko erzielen lassen

Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up

INTRODUCTION: Since the arise of orthogeriatric co-management patients’ outcome and survival has improved. There are several assessment parameters that screen the precondition of orthogeriatric patients including mobility, activities of daily living, comorbidities, place of residence and need for care just to name a few. In a 2-year follow-up on an orthogeriatric co-managed ward the fracture-independent predictive value of typical assessment parameters and comorbidities on the associated mortality was examined. METHODS: All patients treated on an orthogeriatric co-managed ward from February 2014 to January 2015 were included. No fracture entity was preferred. Emphasis was set on following parameters: age, gender, Parker-Mobility Score (PMS), Barthel Index (BI), Charlson-Comorbidity Index (CCI), dementia, depression, sarcopenia, frequent falling, length of stay (LOS), care level (CL) and place of residence (POR). In a 2-year follow-up the patients’ death rates were acquired. SPSS (IBM Corp., Armonk, New York, USA) and Cox regression was used to univariately analyze the expression of the mentioned parameters and mortality course over 2 years from discharge. In a multivariate analysis intercorrelations and independent relationships were examined. RESULTS: A follow-up rate of 79.6% by assessing 661 patients was achieved. In the univariate analysis linear inverse correlation between PMS and BI and mortality and a linear positive correlation between CCI and higher mortality were observed. There was also a significant relationship between lower survival and age, dementia, sarcopenia, frequent falling, higher institutionalized place of residence and higher CL. No univariate correlation between 2-year mortality and gender, depression and LOS was found. In the multivariate Cox regression, the only independent risk factors remaining were lower PMS (HR: 1.81; 95%CI: 1.373–2.397), lower BI (HR: 1.64; 95%CI: 1.180–2.290) and higher age per year (HR: 1.04; 95%CI: 1.004–1.067). CONCLUSION: Age, PMS, BI, CCI, preexisting dementia, sarcopenia, frequent falling, POR and CL are univariate predictors of survival in the orthogeriatric context. An independency could only be found for PMS, BI and age in our multivariate model. This underlines the importance of preexisting mobility and capability of self-support for the patient’s outcome in terms of survival