Background: The optimal setting and design of a comprehensive treatment for elderly hip fracture patients is unknown. The aims of this study were to compare the functional outcomes associated with an innovative comprehensive single-step (geriatric-based) and classic double-step (orthopedic-based) treatment of such patients.
Methods: This is a partially concurrent prospective study, taking place in the orthogeriatric unit of a department of geriatric rehabilitation, in a large urban academic freestanding hospital. The participants were 336 consecutive elderly people, admitted for surgery of extracapsular or intracapsular hip fracture. 204 patients were admitted to the department of orthopedic surgery and transferred, shortly after surgery, to the orthogeriatric ward for ongoing rehabilitation (ORT group). Another 116 patients were admitted directly to a geriatric-based orthogeriatric ward, and they received surgical, medical, and rehabilitation treatment within the same facility (ORTGER group). The main outcome measures were length of stay, absolute functional gains of the motor functional independence measure (FIM), and relative functional motor gains according to the Montebello rehabilitation factor score. Successful rehabilitation was defined as relative functional gain >.5.
Results: 320 patients were included in the final analysis. The two groups were similar, yet ORT-group patients were somewhat younger (p <.02) and were cognitively better preserved (p <.01). Admission cognitive FIM was the strongest positive predictive factor associated with successful rehabilitation (odds ratio = 2.45, 95% confidence interval 1.89-3.31, and p <.001). Significant improvement of total FIM scores occurred during rehabilitation in both groups. The relative functional gain was similar in the two groups, but total hospital length of stay was 5 days shorter in the ORTGER group (p <.01). After the effect of age, sex, length of stay, fracture type, and cognition at onset of the rehabilitation period were adjusted for, patients of the ORTGER group had a twofold chance for successful rehabilitation, compared with ORT-group patients (odds ratio = 1.97, 95% confidence interval 1.09-3.65, and p =.03).
Conclusions: The functional outcome of elderly hip fracture patients is better for those treated in the orthogeriatric setting, as compared with the common two-steps model of orthopedic surgery followed by transfer to a geriatric rehabilitation facility.