Gerontology & Geriatric Research

IMPACT OF A MULTIDISCIPLINARY APPROACH ON MORTALITY AFTER HIP FRACTURE SURGERY

5^th International Conference on Geriatric Medicine & Gerontological Nursing

November 14-15, 2016 | Atlanta, USA

Silvia Forni, F.Pieralli, C.Lorini, A.Sergi, A.Vannuccia and G.Bonaccorsi

University of Florence, Italy

Accepted Abstracts: J Gerontol Geriat Res

Abstract:

Introduction: Since most hip fractures occur in fragile patient�??s, an important advance in the treatment may be a co-managed, multidisciplinary treatment with orthopaedic surgeons and geriatricians. This multidisciplinary care model (MCM) is implemented in some Tuscan hospitals, while in hospitals with an usual care model (UCM) medical consultation is required only as deemed necessary by the admitting surgeon. The primary aim of this study was to assess the effect of MCM on 30-day mortality, compared with UCM. Methods: A retrospective study of patient�??s with a main diagnosis of hip fracture, as reported in the hospital admission discharges, aged 65 years and older, undergoing surgery in Tuscan hospitals from 1 January 2010 to 31 December 2013, has been conducted. A multilevel logistic regression model was performed to assess the effect of MCM v�??s UCM. The Charlson Comorbidity Index (CCI) was used as a proxy of case mix complexity. Results: Patients included was 23,973: 23% men and 77% women; the mean age was 83.5 years; 62.3% of patients were in hospitals with standard care 37.7% in hospitals with multidisciplinary care. The percentage of patients with a CCI of 1 or 2+ was significantly higher in the MCM. Length of stay was higher in MCM than UCM (12.6 days vs 10.3 days). The multilevel analysis showed that mortality was significantly higher in the UCM, after adjusting for gender, age, comorbidity and timing of surgery (OR=1.32; 95% CI 1.09-1.59; p=0.004). Conclusions: A co-managed approach to hip fracture, with orthopaedic surgeons and geriatricians, offers a multidisciplinary pathway for the elderly and leads to reduce mortality after hip fracture surgery.