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Specialist teamwork better for older hip-fracture patients

Patients who undergo hip fracture surgery in hospitals that have an orthogeriatric service have an improved chance of surviving beyond 30 days after surgery, new research shows

Professor Jacqueline Close, from Neuroscience Research Australia and a UNSW conjoint professor in the Prince of Wales Clinical School, and her coauthors, collected data from 9,370 hip fracture patients aged 65 years or older who had surgery at one of the 37 NSW public hospitals treating hip fractures between July 2009 and June 2011.

There were 706 deaths within 30 days of surgery, an overall mortality rate of 7.4%.

However, the 30-day mortality rate (adjusted for age, sex and comorbidities) for patients who were treated in hospitals with an orthogeriatric service was 6.2% compared with 8.4% for those who did not, a significant difference.

Patients who received orthogeriatric care stayed in hospital longer than those who did not, staying a median of 26 days versus 22 days.

Orthogeriatric care, defined as “medical care for older patients with orthopaedic conditions that is provided collaboratively with the treating orthopaedic team … predominantly provided by geriatricians”, was available in 14 of the 37 hospitals included the study.

“The difference in mortality rates may be due to medical optimisation before surgery, prevention and early detection of medical complications, enhanced coordination of care and more effective communication between staff responsible for care”, Professor Close and her coauthors wrote.

“Respiratory disease and cardiac disease are the biggest causes of mortality after hip fracture and … these diseases are likely to be managed better in hospitals with an orthogeriatric service.”

The recently released Australian and New Zealand Guideline for Hip Fracture Care (www.anzhhr.org) provides clear recommendations to support the development and implementation of orthogeriatric services whilst a recent audit of all public hospitals providing hip fracture care across Australia and New Zealand provides data to suggest that availability of these services is increasing. The authors conclude that the Australian and New Zealand Hip Fracture Registry will facilitate collection of patient data that will be integral to driving future service development as well as providing a platform for future research on factors that  affect outcomes. The ultimate goal is improving patient outcomes.

The research was published this week in the Medical Journal of Australia.

Media contact: Siobhan Moylan, NeuRA (02) 9399 1277 or 0406 599 569.