Review Question - QID 210286

All of the answers listed have been demonstrated to be a benefit of orthopaedic geriatric comanagement service EXCEPT for decreased need for a post-discharge rehab facility.

Many institutions have initiated an orthopaedic geriatric comanagement inpatient service, particularly for orthopaedic trauma patients. Such service assists with perioperative medical management, focusing especially on pre-operative optimization, post-operative management of comorbidities, prevention of delirium, and management of dementia. Several studies have demonstrated improved post-operative complication and mortality rates though conflicting evidence exists.

Fisher et al. analyzed a prospective group of 951 patients older than 60 years of age with hip fractures managed on a comanagement service, comparing them to a historical control group. They report a reduction in postoperative medical complications (50% vs 71%), mortality (4.7% vs 7.7%), and re-admission rate to a medical service. They did not find a change in the length of stay or post-discharge disposition. They conclude that combined orthopaedic and geriatric care of elderly patients with hip fractures leads to decreased morbidity and mortality while improving postoperative care.

Friedman et al. analyzed a Geriatric Fracture Center with patients 60 years of age or older with hip fracture and report a shorter time to surgery (24 vs 37 hours), shorter length of stay (4.6 vs 8.3 days), fewer post-operative infections (2% vs 20%), fewer complications overall (31% vs 46%), and lower use of physical restraints (0% vs 14%). They conclude that comanagement of elderly patients with hip fractures leads to improved processes and outcomes.

Prestmo et al. conducted a randomized control trial of usual care vs orthogeriatric comanagement for home-dwelling patients older than 70 years of age with hip fracture. They found that geriatric comanagement patients were significantly more mobile at 4 months following surgery. They concluded that the treatment of geriatric patients with hip fractures should be coordinated through orthogeriatric care.

Incorrect Answers:
Answer 1, 2, 3, 5 - Decreased time to surgery, postoperative mortality, complication rates, and improved postoperative mobility have all been shown in the literature to be benefits of an orthogeriatric comanagement service.