Effect of the orthogeriatric co-management on older hip fracture patients with multimorbidity: a post-hoc exploratory subgroup analysis of a non-randomised controlled trial

Abstract

Background: Hip fracture and multimorbidity represent significant health challenges for older people. Despite evidence that orthogeriatric co-management improves hip fracture management and patients' health outcomes, there is little evidence to understand its effectiveness for patients with multimorbidity. The study aimed to assess the effect of the orthogeriatric co-management care model on older hip fracture patients with multimorbidity.

Methods: This study was a post-hoc analysis of a recently completed trial. Patients were admitted to three urban hospitals and three suburban hospitals in Beijing, with diagnosed hip fracture. One urban hospital (intervention group) implemented the orthogeriatric co-management, while other hospitals (control group) continued orthopedics-led usual care. All enrolled patients were followed-up for three times within one year. Study outcome was patients' one-year cumulative adverse events, including re-operation, complication and death. Logistic regression models were used to compare the differences between the intervention and control groups, with adjustment for all potential confounders.

Result: A total of 2,071 patients with hip fracture (1,110 intervention, 961 control) were included. More than half of the patients had multimorbidity. Hypertension and diabetes were the leading disease cluster, while hypertension was the most prevalent disease condition across all observed disease clusters. Older hip fracture patients with multimorbidity in the intervention group saw a significantly reduced risk of adverse events compared to the control group (Odds Ratio = 0.59, 95% Confidence Interval: 0.48 to 0.73).

Conclusion: Multimorbidity is common among older hip fracture patients. Orthogeriatric co-management provides better outcomes for patients with multimorbidity, in reducing the risk of adverse events after a hip fracture.

Clinical trial registration information: The study was a post-hoc analysis using data from a non-randomized controlled trial. Registry name: Services Mapping Among Older Adults With Hip Fracture (HiFit) ClinicalTrials.gov ID: NCT03184896 URL: https://clinicaltrials.gov/study/NCT03184896.

Keywords: China; Hip fracture; Multimorbidity; Older people; Orthogeriatric care.