Geriatric trauma unit and geriatric rehabilitation

The effect of a Geriatric Trauma Unit on geriatric rehabilitation after hip fracture

Elsje Smit

De abstractcommissie heeft op verzoek van de congrescommissie 5 abstracts geselecteerd die tijdens het Verenso najaarscongres 'Specialist ouderengeneeskunde in the lead' op 30 november 2017 middels een flitspresentatie gepresenteerd worden. Onderstaande abstract is daar een van.

Introduction

In 2011 a geriatric rehabilitation national program was initiated in nursing homes in the Netherlands. In May of 2014 the Tergooi hospital opened a geriatric trauma unit (GTU) for patients over 70 years in age with a traumatic hip fracture. The aim of this study is to investigated whether the treatment of patients, who were operated on due to a hip fracture and went to a geriatric rehabilitation center, has improved since the start of the GTU.

Methods

It was an observational retrospective study. We included patients of 70 years or older with a hip fracture and went to a geriatric rehabilitation center after hospital discharge. We compared patients admitted to the orthopedic or surgical ward in 2013 to patients admitted to the GTU in 2015. Primary outcome was the length of stay in the hospital and rehabilitation center. Secondary outcomes were 30-days and 6-month mortality and complications during rehabilitation (like pneumonia, decubitus, wound infection, bleedings).

Results

105 patients were included in 2013 and 151 patients in 2015. There were no clinical significant differences between both groups for the baseline characteristics. The overall length of stay at hospital and rehabilitation center was 46.5 days in 2013 and 39 days in 2015. The median length of stay in hospital in 2013 was 9 days and 5 days in 2015. The length of stay at rehabilitation center was 37 days in 2013 and 35 days in 2015. Overall there were more complications registered in 2015. But none of these were statistical significant. There was no clinical significant difference in 30-days and 6-months mortality between the two groups.

Discussion

In comparison with previous studies the length of stay on the GTU is shorter than on a general orthopedic or surgical ward.However, this does not result in a decrease in complications and mortality in contrast to other studies. Possibly our patient population is more frail because we included only patients who went to a rehabilitation center after hospital discharge and no patients discharged to home.

Conclusion

The start of an innovative care project, combining the GTU in Tergooi Hospital in the Netherlands with regional geriatric rehabilitation  centers, shows to be a good integrated care system for patients of 70 years or older who were operated on due to a hip fracture.