La frattura di femore nel paziente anziano fragile. L'esperienza della Sezione di Ortogeriatria dell'Ospedale San Gerardo di Monza

The management of hip fracture in frail patients such as older people with comorbidities cannot be limited to the surgical aspect only. The direct and indirect costs of care - usually long-term care - are also very important, as well as any assistance during the whole diagnostic-therapeutic-rehabilitative process. Beside prevention programs, it is necessary to set up clinical-managerial models of care in order to enhance the management of these patients. We analyzed in-patient hospital data of elderly people (>70 years old) admitted with hip fracture to the Department of Traumatology during the year 2006 (group B), and we compared them within-patient data of older people hospitalized at our Orthogeriatric section during the period March 2007-June 2008 (group A). We considered the following outcomes: door-to-bed time, surgical timing, mobilization of the patient, early major complications, hospitalization length. Group A (n=154) had significantly shorter hospitalization than Group B (11.1 versus 13.8, p<0.01), and also a shorter surgical timing (2. 7 versus 3. 7 days, p<0.01). No differences were observed in the door-to-bed time (<120 minutes for both groups) and in the patient's mobilization (both 3.3 days). The reduction of early complications proved to be significant (20.8% versus 25.8%, p<0.01), although the number of chronic diseases at admission was higher in the experimental group (5.0 versus 3.3, p<0.01). Multidisciplinary team working seems to be the better way to manage hip fracture in the elderly. The coordinated cooperation of different professional figures is associated with significant reduction of important clinical outcomes, which results in a shorter hospitalization period, a better treatment of early complications and a faster discharge for rehabilitation. © Dario Cova