Which is the optimal orthogeriatric care model to prevent mortality of elderly subjects post hip fractures? A systematic review and meta-analysis based on current clinical practice
Résumé
BackgroundWhile there is a general consensus of the impact of an orthogeriatric organisation in terms of elderly patient mortality post hip fracture, it is unclear which, among these various care models, is the most optimal.MethodsA systematic review of the literature was undertaken using the keywords Femoral fractures or total hip replacements or Accidental, falls and Aged, 80 and over and Mortality. The review is presented following PRISMA guidance.ResultsEighteen studies were identified, published between 1988 and 2015. The number of elderly subjects participating in these studies was between 37 and 951; their mean age was 82.67.4years, and average mortality in these studies was 17.7%.The odds ratio (OR) and 95% CI for association between implementation of the orthogeriatric model and mortality in all patients studied were 0.85 (0.74-0.97). In the analysis by subgroup on the type of orthogeriatric model, the group Orthogeriatric ward gave homogenous results, with ORs and 95% CIs of 0.62 (0.48-0.80) unlike other models: Shared care by orthopaedists and geriatricians and Geriatric advice in orthopaedic ward.Conclusionsp id=Par5Elderly patients with hip fracture admitted early into any sort of orthogeriatric models or more specifically to a dedicated orthogeriatric ward had reduced long-term mortality. This study has to be completed by RCT showing the efficacy of orthogeriatric ward compared to other models using outcomes such as quality of life or functional recovery.