Implementation of a co-managed Geriatric Fracture Center reduces hospital stay and time-to-operation in elderly femoral neck fracture patients

摘要

Purpose: To evaluate changes in hospital length-of-stay and time-to-operation of older hip fracture patients before and after the foundation of a co-managed Geriatric Fracture Center (GFC). Methods: A co-managed GFC was established in a German level-1 trauma center. In a retrospective cohort study, we analyzed femoral neck fracture patients >60 years treated with hemiarthroplasty. Patients treated within the first year after foundation of the GFC were compared to the patients treated during the year before. One-way ANOVA was performed to identify differences regarding time-to-operation and hospital length-of-stay. Results: One hundred and fourteen patients of the GFC were compared to 169 patients previously treated without co-management. Mean patient age did not significantly differ (81.9 vs. 81.5 years; p = 0.7), nor did gender distribution. Hospital length-of-stay was significantly shorter after foundation of the GFC (13.9 vs. 16.8 days; p = 0.007). The same is true for the interval between hospital admission and operation, which decreased from 3.1 to 2.1 days (p = 0.029). Early surgical complication rate was not significantly affected by GFC foundation (7.7 pre-GFC vs. 9.6 GFC; p = 0.6), nor was inpatient mortality (5.9 pre-GFC vs. 4.4 GFC; p = 0.6). Subgroup analysis revealed that GFC patients without early surgical complications displayed a reduced length-of-stay (LOS), whereas LOS was even prolonged in GFC patients with surgical complications. Conclusions: A co-managed GFC offering an organized fracture program for the elderly can reduce hospital length-of-stay and time-to-operation in hip fracture patients. A significant effect can be observed within the first year after establishment of a GFC.