Orthogeriatric care: improving patient outcomes

Figures & data

Figure 1 Flow chart study selection procedure used in literature search.

Table 1 Summary of the some most relevant studies included in this review

Authors	Year	Country	Sample size	Inclusion criteria	Exclusion criteria	Study design	Conclusion summary	Level of evidence
Brunskill et al^Citation88	2015	UK	Six studies (2,722 participants)	Randomized controlled trials comparing red blood cell transfusion versus no transfusion or an alternative to transfusion, different transfusion protocols, or different transfusion thresholds in hip fracture patients	None specified	Meta-analysis	Liberal versus restricted threshold transfusion: no differences in mortality, at 30 days post-hip fracture surgery (RR 0.92, 95% CI 0.67–1.26) or at 60 days postsurgery (RR 1.08, 95% CI 0.80–1.44); no difference in functional recovery at 60 days; very low-quality evidence of a lower risk of myocardial infarction in the liberal transfusion threshold group (RR 0.59, 95% CI 0.36–0.96)	IA
Liu et al^Citation68	2015	People’s Republic of China	Ten studies (986 patients)	Hip fracture	1) Patients with multiple systemic fractures or pathologic fractures; 2) data without standard deviations; 3) participants with hip fractures who had undergone nonsurgical treatment	Meta-analysis	Perioperative oral nutritional supplementation: higher total protein levels (SMD =1.56 [95% CI 1.06, 2.07]; P=0.00001); less complications after hip surgery (OR =0.49 [95% CI 0.32, 0.73]; P=0.0005); less wound infection (OR =0.17 [95% CI 0.04, 0.79]; P=0.02); less urinary tract infection (OR =0.22 [95% CI 0.05, 0.90]; P=0.03)	IA
Prestmo et al^Citation97	2015	Norway	1,077 patients	Hip fracture patients	None specified	Clinical trial	Functional recovery; mean SPPB scores at 4 months were 5.12 (SE 0.20) for comprehensive geriatric care and 4.38 (SE 0.20) for orthopedic care (between-group difference 0.74, 95% CI 0.18–1.30, P=0.010)	IB
Mazzola et al^Citation111	2015	Italy	275 patients	Hip fracture patients and comorbidity or multiple-drug treatment or use of oral anticoagulants or lack of social support	None specified	Longitudinal cohort study	6-month mortality factors: severe disability (OR 2.24, 95% CI 1.08–4.65) and postoperative delirium (OR 3.80, 95% CI 1.72–8.39)	IIB
Grigoryan et al^Citation25	2014	US	18 studies (9,094 patients)	Hip fracture studies Orthogeriatric multidisciplinary approach	Not English or Spanish studies; not control group studies; published as an abstract or letter; or published >20 years prior to the search period	Meta-analysis	Reduction of in-hospital mortality (RR 0.60; 95% CI 0.43, 0.84) and long-term mortality (RR 0.83; 95% CI 0.74, 0.94); reduction of length of stay (SMD −0.25; 95% CI −0.44, −0.05), particularly in the shared care model (SMD −0.61; 95% CI −0.95, −0.28)	IA
Taraldsen et al^Citation101	2014	Norway	317 patients	Hip fracture patients previously living in their own homes and able to walk 10 m	Patient with pathological fractures, multitrauma injuries, or short life expectancy	Clinical trial	Comprehensive geriatric care; better SPPB score, 1.6 (SD 2.0) versus 1.0 (SD 1.6); P=0.002	IB
Moja et al^Citation27	2012	Italy	35 studies (191,873 patients)	Hip fracture patients aged ≥65 years	None specified	Meta-analysis	Early hip surgery (1–2 days); lower risk of death (OR 0.74 [95% CI 0.67–0.81, P<0.001]); lower risk pressure sores (OR 0.48 [95% CI 0.38–0.60, P<0.001])	IA
Stenvall et al^Citation43	2012	Sweden	64 patients	Hip fracture	Rheumatoid arthritis, severe hip osteoarthritis, severe renal failure, pathological fracture, and being bedridden before the fracture	Clinical trial	Fewer postoperative complications in the intervention group: urinary tract infections 6 (21%) versus 23 (64%), P=0.001; nutritional problems 5 (18%) versus 16 (44%), P=0.025; postoperative delirium 19 (68%) versus 35 (97%), P=0.002; number of delirium days 3.2 (SD 4.1) versus 12.8 (SD 17.6), P=0.003	IB
Carson et al^Citation86	2011	US	2,016 patients	Hip fracture patients with clinical evidence of or risk factors for cardiovascular disease	Unable to walk without human assistance before hip fracture, declined blood transfusions, multiple trauma, pathologic hip fracture associated with cancer, acute myocardial infarction 30 days before randomization, symptoms associated with anemia, actively bleeding at the time of potential randomization	Clinical trial	Blood transfusion (OR in the liberal strategy group 1.01; 95% CI 0.84–1.22), absolute risk difference of 0.5 percentage points (95% CI −3.7–4.7); in-hospital acute coronary syndrome (absolute risk difference −0.9%; 99% CI −3.3–1.6), and death on 60-day follow-up (absolute risk difference 1.0%; 99% CI −1.9–4.0)	IB
Simunovic et al^Citation29	2010	Canada	Five observational studies (n=4,208)	Hip fracture patients	None	Meta-analysis	Earlier surgery; lower mortality risk (RR 0.81, 95% CI 0.68–0.96, P=0.01); reduced in-hospital pneumonia (RR 0.59, 95% CI 0.37–0.93, P=0.02); reduced pressure sores (RR 0.48, 95% CI 0.34–0.69, P<0.001)	IA

Notes: Levels of evidence for therapeutic studies: IA, systematic review (with homogeneity) of RCTs; IB, individual RCT (with narrow confidence intervals); IIB, individual cohort study (including low quality RCT, eg, <80% follow-up); II, small RCTs with unclear results.

Abbreviations: RR, risk ratio; CI, confidence interval; OR, odds ratio; SPPB, Short Physical Performance Battery; SE, standard error; SD, standard deviation; SMD, standard mean difference; RR, relative risk; RCT, randomized control trials.

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