Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population

Sarah J Mant; Chibuchi Amadi-Livingstone; Mohamed H Ahmed; Maria Panourgia; Henry Owles; Oliver Pearce

doi:10.3390/life14040503

Orthogeriatric Care Following Hip Fracture: Improving Post-Operative Outcomes in an Aged Population

Life (Basel). 2024 Apr 14;14(4):503. doi: 10.3390/life14040503.

Authors

Sarah J Mant¹, Chibuchi Amadi-Livingstone¹, Mohamed H Ahmed^{2

3

4}, Maria Panourgia^{3

4}, Henry Owles³, Oliver Pearce⁵

Affiliations

¹ The Medical School, University of Buckingham, Buckingham MK18 1EG, UK.
² Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK.
³ Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK.
⁴ Honorary senior lecturer. Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham MK18 1EG, UK.
⁵ Department of Trauma and Orthopedics, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK.

Abstract

Introduction: Hip fractures globally are associated with high levels of morbidity, mortality, and significant financial burden. This audit aimed to assess the impact of orthogeriatric liaison care on post-operative outcomes following surgical management of neck or femur fractures.

Methods: Here, 258 patients who underwent hip fracture surgery over 1-year were included. Data were collected as an audit following the transition to an orthogeriatric liaison care model, involving regular orthogeriatric review (thrice weekly ward rounds, daily board rounds), superseding orthogeriatric review as requested. The audit is meant to assess the development of post-operative non-surgical site infection (NSSI) and mortality and duration of inpatient stay. Outcomes were compared to previous data from our hospital site in 2015/2016.

Results: Patients with severe cognitive impairment and systemic disease (Abbreviated Mental Test Score (AMTS) < 7 and American Society of Anesthesiologists (ASA) grade ≥ 3) showed significantly elevated NSSI risk, consistent across the study periods. Both periods demonstrated an increased risk of NSSI associated with admission from nursing homes. Despite the 2021/2022 cohort being notably older, NSSI risk decreased from 40.6% to 37.2% after implementing the orthogeriatric care model. NSSI risk was notably reduced for severe cognitive impairment (51.6% vs. 71%), and the p-value was 0.025. Average hospital stay decreased post-intervention (2.4 days shorter), with a notable reduction for NSSI patients (3.4 days shorter). Overall mortality rates were similar, although mortality due to infection was significantly reduced in 2021/2022 (44.4% vs. 93.3%), and the p-value was 0.003.

Conclusion: The orthogeriatric liaison care model significantly decreased NSSI only in individuals with severe cognitive impairment and infection-associated mortality. This highlights the integral role of orthogeriatricians in the care of elderly hip fracture patients.

Keywords: cognitive impairment; non-surgical site infection; orthogeriatric; post-operative care.

Grants and funding

This research received no external funding.