Postoperative Admission to a Dedicated Geriatric Unit Decreases Mortality in Elderly Patients with Hip Fracture

Jacques Boddaert (1, 2) , Judith Cohen-Bittan (1) , Frédéric Khiami (2) , Yannick Le Manach (3) , Mathieu Raux (1, 2) , Jean-Yves Beinis (4) , Marc Verny (1, 2) , Bruno Riou (2, 1)

1 Neurophysiologie Respiratoire Expérimentale et Clinique
2 CHU Pitié-Salpêtrière [AP-HP]
3 McMaster University [Hamilton, Ontario]
4 CHU Charles Foix [AP-HP]

Background Elderly patients with hip fracture have a 5 to 8 fold increased risk of death during the months following surgery. We tested the hypothesis that early geriatric management of these patients focused on co-morbidities and rehabilitation improved long term mortality. Methods and Findings In a cohort study over a 6 year period, we compared patients aged >70 years with hip fracture admitted to orthopedic versus geriatric departments in a time series analysis corresponding to the creation of a dedicated geriatric unit. Co-morbidities were assessed using the Cumulative Illness Rating Scale (CIRS). Each cohort was compared to matched cohorts extracted from a national registry (n = 51,275) to validate the observed results. Main outcome measure was 6-month mortality. We included 131 patients in the orthopedic cohort and 203 in the geriatric cohort. Co-morbidities were more frequent in the geriatric cohort (median CIRS: 8 vs 5, P<0.001). In the geriatric cohort, the proportion of patients who never walked again decreased (6% versus 22%, P<0.001). At 6 months, re-admission (14% versus 29%, P = 0.007) and mortality (15% versus 24%, P = 0.04) were decreased. When co-morbidities were taken into account, the risk ratio of death at 6 months was reduced (0·43, 95%CI 0·25 to 0·73, P = 0.002). Using matched cohorts, the average treatment effects on the treated associated to early geriatric management indicated a reduction in hospital mortality (−63%; 95% CI: −92% to −6%, P = 0.006). Conclusions Early admission to a dedicated geriatric unit improved 6-month mortality and morbidity in elderly patients with hip fracture.

Domaines: Médecine humaine et pathologie

Jacques Boddaert, Judith Cohen-Bittan, Frédéric Khiami, Yannick Le Manach, Mathieu Raux, et al.. Postoperative Admission to a Dedicated Geriatric Unit Decreases Mortality in Elderly Patients with Hip Fracture. PLoS ONE, 2014, 9 (1), pp.e83795. ⟨10.1371/journal.pone.0083795⟩. ⟨hal-01344762⟩