Orthogeriatric co-management reduces incidence of delirium in hip fracture patients

SUMMARY: Hip fracture patients often display an acute confusional state (delirium) which is associated with worse outcomes. In this observational study, we found that co-management of hip fracture patients by a multidisciplinary team including a geriatrician and an orthopaedic surgeon could reduce t...

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Detalles Bibliográficos
Autores principales: Pollmann, C. T., Mellingsæter, M.R., Neerland, B.E., Straume-Næsheim, T., Årøen, A., Watne, L.O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer London 2021
Materias:
Original Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8563591/
https://www.ncbi.nlm.nih.gov/pubmed/33963884
http://dx.doi.org/10.1007/s00198-021-05974-8
Descripción
Sumario:SUMMARY: Hip fracture patients often display an acute confusional state (delirium) which is associated with worse outcomes. In this observational study, we found that co-management of hip fracture patients by a multidisciplinary team including a geriatrician and an orthopaedic surgeon could reduce the incidence of delirium. INTRODUCTION: Delirium after hip fracture is common and is associated with negative outcomes. We investigated if orthogeriatric co-management reduced the incidence of delirium in hip fracture patients. METHODS: In this single-centre, prospective observational study, we compared the incidence of delirium and subsyndromal delirium (SSD) before (usual care group, n = 94) and after (orthogeriatric group, n = 103) the introduction of orthogeriatric co-management as an integrated care model. The outcome measure ‘no delirium/SSD/delirium’ was treated as an ordinal variable and analysed using the chi-squared test and multivariable ordinal logistic regression. RESULTS: The groups had similar baseline characteristics except for a higher proportion of patients with pre-existing cognitive impairment in the usual care group (51% vs. 37%, p = 0.045). Fewer patients in the orthogeriatric group developed SSD or delirium (no delirium: 59% vs. 40%/SSD: 6% vs. 13%/delirium: 35% vs. 47%; p = 0.021). The number needed to treat (NNT) to avoid one case of SSD or delirium was 5.3 (95% CI: 3.1 to 19.7). In a multivariable analysis adjusted for age, sex, ASA class, pre-existing cognitive impairment, time to surgery, type of surgery, and medical or surgical complications, the odds ratio for the development of SSD/delirium was lower in the orthogeriatric group (OR = 0.46, 95% CI: 0.23–0.89, p = 0.023). CONCLUSION: Orthogeriatric co-management as an integrated care model reduced the incidence of SSD/delirium in hip fracture patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00198-021-05974-8.

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