medigraphic.com
ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2021, Number 2

<< Back Next >>

Acta Ortop Mex 2021; 35 (2)

Quality indicators in hip fracture care after the implementation of an orthogeriatrics team

Viveros-García J, Guillermo-Nuncio E, Nieto-Sandoval H, Baldenebro-Lugo L

Language: Spanish
References: 44
Page: 181-187
PDF size: 189.90 Kb.


ABSTRACT

Introduction: The incidence of hip fracture will increase dramatically in the coming decades. It has been associated with high mortality and morbidity. Orthogeriatric programs have improved outcomes in fragility hip fracture worldwide. There is little evidence in Mexico on the impact of orthogeriatrics and adherence to quality indicators. Objective: To compare adherence to quality indicators in hip fracture before and after the implementation of an orthogeriatrics team compared to the traditional model. Material and methods: Quasi-experimental study conducted in León, Mexico. Adherence to quality indicators before and after an interconsultant orthogeriatrics team was compared. The indicators measured were: surgical delay, treatment for osteoporosis, early mobilization, type of implant and delirium. Results: We included 83 patients. The surgical delay was reduced from 144 to 116 hours (28 hours), the percentage of patients with early surgery was increased from 7.9 to 18%, in addition the percentage of patients with treatment for osteoporosis was increased and the incidence of delirium was reduced. Conclusion: Adherence to indicators is low, however, it was possible to discreetly increase adherence to these indicators. Internal policies must be generated in public hospitals to improve this adherence and see its impact on long-term outcomes.


REFERENCES

  1. International Osteoporosis Foundation IO. La Carga Global de la Osteoporosis en Cifras. 2016: 40. https://www.iofbonehealth.org/sites/default/files/media/PDFs/Fact Sheets/2014-Factsheet-Burden_Osteoporosis-A4-ES.pdf

  2. International Osteoporosis Foundation. Hip Fracture Incidence Map | International Osteoporosis Foundation. Available in: https://www.iofbonehealth.org/facts-and-statistics/hip-fracture-incidence-map

  3. Maggi S, Kelsey JL, Litvak J, Heyse SP. Incidence of hip fractures in the elderly: a cross-national analysis. Osteoporos Int. 1991; 1(4): 232-41.

  4. Azagra R, Martin-Sánchez JC, Aguyé A. Europe PMC Funders Group Changing trends in the epidemiology of hip fracture in Spain. Osteoporos Int. 2014; 25(4): 1267-74. doi: 10.1007/s00198-013-2586-0.

  5. Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992; 2(6): 285-9. Available in: http://www.ncbi.nlm.nih.gov/pubmed/1421796

  6. Mow TC, Lukeis J, Sutherland AG. The benefits of streamlined hip fracture management in a regional hospital. Geriatr Orthop Surg Rehabil. 2017; 8(2): 99-103. doi: 10.1177/2151458516689284.

  7. Clark P, Lavielle P, Franco-Marina F, et al. Incidence rates and life-time risk of hip fractures in Mexicans over 50 years of age: a population-based study. Osteoporos Int. 2005; 16(12): 2025-30. doi: 10.1007/s00198-005-1991-4.

  8. Alarcón T, Gonzalez-Montalvo JI, Gotor P, Madero R, Otero A. A new hierarchical classification for prognosis of hip fracture after 2 years' follow-up. J Nutr Health Aging. 2011; 15(10): 919-23. doi: 10.1007/s12603-011-0129-y.

  9. Ojeda-Thies C, Sáez-López P, Currie CT, et al. Spanish National Hip Fracture Registry (RNFC): analysis of its first annual report and international comparison with other established registries. Osteoporos Int. 2019; 30(6): 1243-54. doi: 10.1007/s00198-019-04939-2.

  10. Hashmi A, Ibrahim-Zada I, Rhee P, et al. Predictors of mortality in geriatric trauma patients. J Trauma Acute Care Surg. 2014; 76(3): 894-901. doi: 10.1097/TA.0b013e3182ab0763.

  11. Sáez P, González-Montalvo JI, Alarcón-Alarcón T, Gotor-Pérez P, Martín-Maestre I. ¿Es posible mejorar la atención al paciente con fractura de cadera? Aportaciones del programa Fonda. 3a Actual en Ortogeriatría Ávila. 2015; 308.

  12. Viveros-García JC, Torres-Gutiérrez JL, Alarcón-Alarcón T, Condorhuamán-Alvarado PY, Sánchez-Rábago CJ, Gil-Garay E G-MJ. Fractura de cadera por fragilidad en México: ¿En dónde estamos hoy? ¿Hacia dónde queremos ir? Acta Ortop Mex. 2018; 32(6): 334-41.

  13. Alsawadi A, Loeffler M. Graduated compression stockings in hip fractures. Ann R Coll Surg Engl. 2012; 94 (7): 463-7. doi: 10.1308/003588412X13171221592492.

  14. National Institute of Health and Care Excellence (NICE). Hip fracture management (CG124). 2011; 1-19. Available in: https://www.nice.org.uk/guidance/cg124/resources/hip-fracture-management-pdf-35109449902789.

  15. Approvals R, Ethics F. Best practice tariff (BPT) for fragility hip fracture care user guide. 2010; 1-10. Available in: http://www.dh.gov.uk/pbr%0Ahttp://www.nigb.nhs.uk/ecc%0Ahttp://www.nigb.nhs.uk/ecc/meetings/

  16. Prestmo A, Hagen G, Sletvold O, et al. Comprehensive geriatric care for patients with hip fractures: A prospective, randomised, controlled trial. Lancet. 2015; 385(9978): 1623-33. doi: 10.1016/S0140-6736(14)62409-0.

  17. González MJI, Gotor PP, Martín VA, et al. La unidad de ortogeriatría de agudos. Evaluación de su efecto en el curso clínico de los pacientes con fractura de cadera y estimación de su impacto económico. Rev Esp Geriatr Gerontol. 2011; 46(4): 193-9. doi: 10.1016/j.regg.2011.02.004.

  18. Neuburger J, Currie C, Wakeman R, et al. Increased orthogeriatrician involvement in hip fracture care and its impact on mortality in England. Age Ageing. 2017; 46(2): 187-92. doi: 10.1093/ageing/afw201.

  19. González-Montalvo JI, Teresa A, Gotor P, Río M Del, Sáez P, Bárcena A. La intervención geriátrica puede mejorar el curso clínico de los ancianos frágiles con fractura de cadera. [Geriatr Manag frail Elder with hip Fract may Improv their clinical outcome]. Med Clin (Barc). 2001; 116: 1-5. doi: 10.1016/S0025-7753(01)71699-5.

  20. Giusti A, Barone A. Optimal setting and care organization in the management of older adults with hip fracture. Eur J Phys Rehabil. 2011; 47(2): 281-96. doi: 10.4081/gc.2015.5602.

  21. Buecking B, Timmesfeld N, Riem S, et al. Early orthogeriatric treatment of trauma in the elderly: a systematic review and metaanalysis. Dtsch Arztebl Int. 2013; 110(15): 255-62. doi: 10.3238/arztebl.2013.0255.

  22. Pareja Sierra T, Rodríguez Solis J, Alonso Fernández P, Torralba González de Suso M, Hornillos Calvo M. Intervención geriátrica en el anciano ingresado por fractura de cadera en el Hospital Universitario de Guadalajara: repercusión clínica, asistencial y económica. Rev Esp Geriatr Gerontol. 2017; 52(1): 27-30. doi: 10.1016/j.regg.2016.02.001.

  23. Marsh D, Palm H. Rising to the challenge of fragility fractures. Injury. 2018; 49(8): 1392. doi: 10.1016/j.injury.2018.06.029.

  24. Pioli G, Bendini C, Pignedoli P, Giusti A, Marsh D. Orthogeriatric co-management-managing frailty as well as fragility. Injury. 2018; 49(8): 1398-402. doi: 10.1016/j.injury.2018.04.014.

  25. Sabharwal S, Wilson H. Orthogeriatrics in the management of frail older patients with a fragility fracture. Osteoporos Int. 2015; 26(10): 2387-99. doi: 10.1007/s00198-015-3166-2.

  26. Falasci P, Marsh D. Orthogeriatrics. (Falaschi P, Marsh DR, eds.). Cham: Springer International Publishing; 2017. doi: 10.1007/978-3-319-43249-6.

  27. Viveros-García J. Ortogeriatría en México: un futuro posible. Med Int Méx. 2019; 35(1): 150-3. doi: 10.24245/mim.

  28. Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil. 2007; 88(10): 1314-19. doi: 10.1016/j.apmr.2007.06.764.

  29. Duarte-Flores JO. Las unidades de ortogeriatría en México son una prioridad. Rev Med Inst Mex Seguro Soc. 2018; 56(4): 332-33.

  30. Dinamarca MJ, Améstica LG, Carrasco BA. Mortalidad intrahospitalaria en adultos mayores chilenos con fractura de cadera: incidencia, causas y otros elementos de interés. Rev Chil Ortop y Traumatol. 2018; 59(02): 041-6. doi: 10.1055/s-0038-1668593.

  31. Dinamarca-Montecinos JL, Améstica-Lazcano G, Rubio-Herrera R, Carrasco-Buvinic A, Vásquez A. Características epidemiológicas y clínicas de las fracturas de cadera en adultos mayores en un hospital público chileno. Rev Med Chil. 2015; 143(12): 1552-9. doi: 10.4067/S0034-98872015001200008.

  32. Ortogeriatría. 2016. Available in: https://www.fsfb.org.co/wps/portal/fsfb/inicio/servicioensalud/servicios-y-especialidades/sectionItem/ortogeriatria

  33. Sáez-López P, Ojeda-Thies C, Alarcón T, et al. Registro Nacional de Fractura de Cadera.; 2018. Available in: http://rnfc.es/wp-content/uploads/2019/11/Informe-Anual-RNFC-2018.pdf

  34. Royal College of Physicians. National Hip Fracture Database (NHFD) Annual Report 2019.; 2019. Available in: https://www.nhfd.co.uk/

  35. ANZHFR. ANZHFR Bi-National Annual Report for Hip Fracture Care 2017.; 2017.

  36. Scottish Hip Fracture Audit. Scottish Hip Fracture Care Pathway Report 2017. 2017: 1-44. Available in: www.shfa.scot.nhs.uk

  37. Gjertsen JE, Engesaeter LB, Furnes O, et al. The norwegian hip fracture register: experiences after the first 2 years and 15,576 reported operations. Acta Orthop. 2008; 79(5): 583-93. doi: 10.1080/17453670810016588.

  38. Cañon AP. Correlación del estado funcional y nutricional en ancianos hospitalizados con fractura de cadera en un hospital de alta complejidad. Univ Méd ISSN 0041-9095. 2015; 56(2): 136-44. doi: 10.1109/ciced.2018.8592188.

  39. CB JL. Artroplastía de cadera secundaria a fractura en el hospital de atención integral del adulto mayor en Quito. 2019; 4(1). Tesis. doi: 1037//0033-2909.I26.1.78.

  40. Baroni M, Serra R, Boccardi V, et al. The orthogeriatric comanagement improves clinical outcomes of hip fracture in older adults. Osteoporos Int. 2019; 30(4): 907-16. doi: 10.1007/s00198-019-04858-2.

  41. Mitchell P, Akesson K. How to prevent the next fracture. Injury. 2018; 49(8): 1424-9. doi: 10.1016/j.injury.2018.06.031.

  42. Akesson K, Marsh D, Mitchell PJ, et al. Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int. 2013; 24(8): 2135-52. doi: 10.1007/s00198-013-2348-z.

  43. Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001; 49(5): 516-22. Available in: http://www.ncbi.nlm.nih.gov/pubmed/11380742

  44. Chuan A, Zhao L, Tillekeratne N, et al. The effect of a multidisciplinary care bundle on the incidence of delirium after hip fracture surgery: a quality improvement study. Anaesthesia. 2020; 75(1): 63-71. doi: 10.1111/anae.14840.



EVIDENCE LEVEL

IV




2020     |     www.medigraphic.com