Geriatric Orthopaedic Surgery & Rehabilitation. 8(4):183–191, DEC 2017
DOI: 10.1177/2151458517716516
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PMID: 29318079
Issn Print: 2151-4585
Publication Date: 2017/12/01
The Effect of an In-Hospital Comprehensive Geriatric Assessment on Short-Term Mortality During Orthogeriatric Hip Fracture Program—Which Patients Benefit the Most?
Hanna Pajulammi;Harri Pihlajamäki;Tiina Luukkaala;Janne Jousmäki;Pekka Jokipii;Maria Nuotio;
+ Author Information
1Department of Geriatric Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland2Division of Orthopedics and Traumatology, Seinäjoki Central Hospital, Seinäjoki, Finland3University of Tampere, Seinäjoki, Finland4Research and Innovation Center, Tampere University Hospital, Tampere, Finland5Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland
Abstract
To examine the association of patient-related factors with the effect of an in-hospital comprehensive geriatric assessment (CGA) on hip fracture mortality.Population-based, prospective data were collected on 1425 consecutive hip fracture patients aged ≥65 in a central hospital providing orthogeriatric service. Outcome was mortality at 1 month after hip fracture associated with receiving versus not receiving CGA.Of the patients receiving CGA compared to those who did not, 8.5% versus12.0% had died within 1 month of the hip fracture (P = .028). In the age- and sex-adjusted Cox proportional hazards model, CGA was associated with a decreased risk of 1-month mortality in patients aged 80 to 89 years (hazard ratio [HR] 0.46, 95% confidence interval [CI]: 0.29-0.73), females (HR: 0.57, 95% CI: 0.38-0.86), having American Society of Anesthesiologists (ASA) score 1 to 3 (HR: 0.60, 95% CI: 0.37-0.99), taking 4 to 10 daily medications (HR: 0.59, 95% CI: 0.38-0.91), with a diagnosis of memory disorder (HR: 0.50, 95% CI: 0.29-0.88), with an estimated glomerular filtration rate <30 mL/min/1.73m2 (HR: 0.28, 95% CI: 0.10-0.76), or living in an assisted living accommodation (HR: 0.40, 95% CI: 0.21-0.76).Several modifiable and patient-related factors were associated with decreased risk of 1-month mortality when CGA was performed during hospitalization for hip fracture. Between “younger and fitter” and “oldest and frailest,” there is a large group of hip fracture patients whose survival can be improved by in-hospital CGA.
