I.CHUA1, R.RAMASON1, W.H.W.KOO1, W.L.S.TAI1, L.T.KU1
Tan Tock Seng Hospital1
Recent studies showed that non-hip fragility lower limb fractures, like hip fractures, contribute significantly to healthcare and socioeconomic burden with loss of quality of life and excess mortality exceeding that of hip fractures. As a leading centre in orthogeriatric care, our highly successful orthogeriatric care was expanded to include this group of fragility fractures.
In this prospective cohort study, admitted patients with major non-hip lower limb fragility fractures (femur, patella, tibia, ankle, periprosthetic, peri-implant, acetabulum) aged 60 years and above were targets for orthogeriatric intervention. Key data (length of stay, inpatient mortality, 30-day readmission, complications) on these patients was collected prospectively during the 4-month pre-intervention (Usual Care group) and 5-month post-intervention (Orthogeriatric Care group) period. Secondary outcomes were falls assessment, bone health evaluation, inpatient referrals, and discharge destination.
Both groups were comparable in mean age and proportion operated. Operated patients in the Orthogeriatric Care group had shorter length of stay of 2 days (Orthogeriatric Care 9.8 days, Usual Care 12.1 days). Orthogeriatric Care group had fewer complications (Orthogeriatric Care 0.1 per patient, Usual Care 0.28 per patient) with relative risk reduction of 64%. In the Orthogeriatric Care group, all patients received falls assessment, more had completed assessment of bone health, and higher proportion discharged to community hospital for rehabilitation. There were no differences in inpatient mortality, 30-day readmissions and number of inpatient referrals across the 2 groups.
Orthogeriatric care should be expanded to major lower limb fragility fractures, resulting in better care, shorter acute hospital stay and fewer complications.