Research progress of multidisciplinary team co-management models for geriatric hip fracture treatment_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Yangyang ^1,2,3,4 ,  RUI Yunfeng ^1,2,3,4 , LU Panpan ^1,2,3,4 , QIU Xiaodong ^3,5 , ZOU Jihong ^3,6 , LI Xingjuan ^3,6 , REN Liqun ^3,6 , LIU Songqiao ^3,7 , YANG Yi ^3,7 , MA Ming ^3,8 , WANG Chen ^1,2,3,4 , CHEN Hui ^1,2,3,4

1. Department of Traumatic Orthopedics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
2. Trauma Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
3. Multidisciplinary Team (MDT) for Geriatric Hip Fracture Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
4. Institute of Traumatic Orthopedics, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
5. Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
6. Department of Geriatrics, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
7. Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;
8. Department of Rehabilitation Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing Jiangsu, 210009, P.R.China;

Corresponding author：

RUI Yunfeng, Email: ruiyunfeng@126.com

Keywords：

Geriatric hip fracture; multidisciplinary team; co-management

DOI：

10.7507/1002-1892.201904133

Video：

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Objective To summarize the research progress of multidisciplinary team (MDT) co-management models in the clinical treatment of geriatric hip fractures.Methods The literature about types and characteristics of MDT for geriatric hip fracture treatment were extensively reviewed, and the advantages of its clinical application were analysed and summarised. Finally, the MDT model and characteristics of geriatric hip fracture in the Zhongda Hospital affiliated to Southeast University were introduced in detail.Results Clinical models of MDT are diverse and have their own characteristics, and MDT can shorten the length of stay and waiting time before operation, reduce the incidence of internal complications, save labor costs, and reduce patient mortality.Conclusion The application of MDT in the treatment of geriatric hip fracture has achieved remarkable results, which provides an optimal scheme for the treatment of geriatric hip fracture.

Citation： ZHOU Yangyang, RUI Yunfeng, LU Panpan, QIU Xiaodong, ZOU Jihong, LI Xingjuan, REN Liqun, LIU Songqiao, YANG Yi, MA Ming, WANG Chen, CHEN Hui. Research progress of multidisciplinary team co-management models for geriatric hip fracture treatment. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(1): 132-138. doi: 10.7507/1002-1892.201904133 Copy

1.	Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ, 1993, 307(6914): 1248-1250.
2.	张英泽. 临床创伤骨科流行病学. 北京: 人民卫生出版社, 2009: 151-154.
3.	Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int, 1992, 2(6): 285-289.
4.	Leng SX, Tian X, Liu X, et al. An international model for geriatrics program development in China: the Johns Hopkins-Peking Union Medical College experience. J Am Geriatr Soc, 2010, 58(7): 1376-1381.
5.	Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ, 2005, 331(7529): 1374.
6.	中华医学会麻醉学分会老年人麻醉学组, 中华医学会麻醉学分会骨科麻醉学组. 中国老年髋部骨折患者麻醉及围术期管理指导意见. 中华医学杂志, 2017, 97(12): 897-905.
7.	Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth, 2008, 55(3): 146-154.
8.	Gilchrist WJ, Newman RJ, Hamblen DL, et al. Prospective randomised study of an orthopaedic geriatric inpatient service. BMJ, 1988, 297(6656): 1116-1118.
9.	Kennie DC, Reid J, Richardson IR, et al. Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial. BMJ, 1988, 297(6656): 1083-1086.
10.	Pioli G, Giusti A, Barone A. Orthogeriatric care for the elderly with hip fractures: where are we? Aging Clin Exp Res, 2008, 20(2): 113-122.
11.	Zuckerman JD, Sakales SR, Fabian DR, et al. Hip fractures in geriatric patients. Results of an interdisciplinary hospital care program. Clin Orthop Relat Res, 1992, (274): 213-225.
12.	Antonelli Incalzi R, Gemma A, Capparella O, et al. Continuous geriatric care in orthopedic wards: a valuable alternative to orthogeriatric units. Aging (Milano), 1993, 5(3): 207-216.
13.	Cogan L, Martin AJ, Kelly LA, et al. An audit of hip fracture services in the Mater Hospital Dublin 2001 compared with 2006. Ir J Med Sci, 2010, 179(1): 51-55.
14.	Boyd RV, Hawthorne J, Wallace WA, et al. The Nottingham orthogeriatric unit after 1000 admissions. Injury, 1983, 15(3): 193-196.
15.	杨明辉, 吴新宝, 龚晓峰, 等. 骨科与老年科共管模式治疗老年髋部骨折及与英国的比较. 中国骨与关节杂志, 2017, 6(3): 169-173.
16.	吴新宝, 杨明辉, 张萍, 等. 老年病科和骨科共管模式缩短老年髋部骨折患者术前等待时间和住院时间. 骨科临床与研究杂志, 2017, 2(2): 96-100.
17.	Pioli G, Davoli ML, Pellicciotti F, et al. Comprehensive care. Eur J Phys Rehabil Med, 2011, 47(2): 265-279.
18.	Christie J, Macmillan M, Currie C, et al. Improving the experience of hip fracture care: A multidisciplinary collaborative approach to implementing evidence-based, person-centred practice. Int J Orthop Trauma Nurs, 2015, 19(1): 24-35.
19.	Middleton M, Wan B, da Assunçao R. Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing, 2017, 46(3): 465-470.
20.	Kristensen PK, Thillemann TM, Søballe K, et al. Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study. Age Ageing, 2016, 45(1): 66-71.
21.	鲁攀攀, 马彬彬, 李荥娟, 等. 老年髋部骨折患者术前营养不良的危险因素分析. 中华老年骨科与康复电子杂志, 2018, 4(3): 145-150.
22.	Bell JJ, Bauer JD, Capra S, et al. Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients-results of a pragmatic intervention. Clin Nutr, 2014, 33(6): 1101-1107.
23.	Hoekstra JC, Goosen JH, de Wolf GS, et al. Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study. Clin Nutr, 2011, 30(4): 455-461.
24.	Arshi A, Rezzadeh K, Stavrakis AI, et al. Standardized hospital-based care programs improve geriatric hip fracture outcomes: an analysis of the ACS NSQIP targeted hip fracture series. J Orthop Trauma, 2019, 33(6): e223-e228.
25.	Deschodt M, Braes T, Broos P, et al. Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. J Am Geriatr Soc, 2011, 59(7): 1299-1308.
26.	Folbert E, Smit R, van der Velde D, et al. Multidisciplinary integrated care pathway for elderly patients with hip fractures: implementation results from Centre for Geriatric Traumatology, Almelo, The Netherlands. Ned Tijdschr Geneeskd, 2011, 155(26): A3197.
27.	Loizzo M, Gallo F, Caruso D. Reducing complications and overall healthcare costs of hip fracture management: a retrospective study on the application of a Diagnostic Therapeutic Pathway in the Cosenza General Hospital. Ann Ig, 2018, 30(3): 191-199.
28.	Pioli G, Bendini C, Pignedoli P, et al. Orthogeriatric co-management-managing frailty as well as fragility. Injury, 2018, 49(8): 1398-1402.
29.	Fernández-Ibáñez JM, Morales-Ballesteros MC, Crespo-Romero E, et al. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol, 2017, 61(2): 88-95.
30.	Watne LO, Torbergsen AC, Conroy S, et al. The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Med, 2014, 12: 63.
31.	Shyu YI, Liang J, Tseng MY, et al. Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture. J Gerontol A Biol Sci Med Sci, 2013, 68(2): 188-197.
32.	Shyu YI, Tseng MY, Liang J, et al. Interdisciplinary intervention decreases cognitive impairment for older Taiwanese with hip fracture: 2-year follow-up. Int J Geriatr Psychiatry, 2013, 28(12): 1222-1231.
33.	Deschodt M, Braes T, Flamaing J, et al. Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc, 2012, 60(4): 733-739.
34.	Stenvall M, Berggren M, Lundström M, et al. A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia—subgroup analyses of a randomized controlled trial. Arch Gerontol Geriatr, 2012, 54(3): e284-e289.
35.	Casey SD, Stevenson DE, Mumma BE, et al. Emergency department pain management following implementation of a geriatric hip fracture program. West J Emerg Med, 2017, 18(4): 585-591.
36.	Miura LN, DiPiero AR, Homer LD. Effects of a geriatrician-led hip fracture program: improvements in clinical and economic outcomes. J Am Geriatr Soc, 2009, 57(1): 159-167.
37.	Kates SL. Hip fracture programs: are they effective?. Injury, 2016, 47(Suppl 1): S25-S27.
38.	Pedersen SJ, Borgbjerg FM, Schousboe B, et al. A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc, 2008, 56(10): 1831-1838.
39.	Gregersen M, Mørch MM, Hougaard K, et al. Geriatric intervention in elderly patients with hip fracture in an orthopedic ward. J Inj Violence Res, 2012, 4(2): 45-51.
40.	Collinge CA, McWilliam-Ross K, Beltran MJ, et al. Measures of clinical outcome before, during, and after implementation of a comprehensive geriatric hip fracture program: is there a learning curve? J Orthop Trauma, 2013, 27(12): 672-676.
41.	Lau TW, Fang C, Leung F. The effectiveness of a multidisciplinary hip fracture care model in improving the clinical outcome and the average cost of manpower. Osteoporos Int, 2017, 28(3): 791-798.
42.	Swart E, Vasudeva E, Makhni EC, et al. Dedicated perioperative hip fracture comanagement programs are cost-effective in high-volume centers: an economic analysis. Clin Orthop Relat Res, 2016, 474(1): 222-233.
43.	谢添, 马彬彬, 李荥娟, 等. 加速康复外科在老年髋部骨折的研究现状. 中国修复重建外科杂志, 2018, 32(8): 1038-1046.
44.	刘佳鑫, 陈力, 段鑫, 等. 术前早期下地活动对老年髋部骨折患者术后生活自理能力的影响. 中国修复重建外科杂志, 2019, 33(3): 318-322.

1. Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ, 1993, 307(6914): 1248-1250.
2. 张英泽. 临床创伤骨科流行病学. 北京: 人民卫生出版社, 2009: 151-154.
3. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int, 1992, 2(6): 285-289.
4. Leng SX, Tian X, Liu X, et al. An international model for geriatrics program development in China: the Johns Hopkins-Peking Union Medical College experience. J Am Geriatr Soc, 2010, 58(7): 1376-1381.
5. Roche JJ, Wenn RT, Sahota O, et al. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ, 2005, 331(7529): 1374.
6. 中华医学会麻醉学分会老年人麻醉学组, 中华医学会麻醉学分会骨科麻醉学组. 中国老年髋部骨折患者麻醉及围术期管理指导意见. 中华医学杂志, 2017, 97(12): 897-905.
7. Shiga T, Wajima Z, Ohe Y. Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression. Can J Anaesth, 2008, 55(3): 146-154.
8. Gilchrist WJ, Newman RJ, Hamblen DL, et al. Prospective randomised study of an orthopaedic geriatric inpatient service. BMJ, 1988, 297(6656): 1116-1118.
9. Kennie DC, Reid J, Richardson IR, et al. Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomised clinical trial. BMJ, 1988, 297(6656): 1083-1086.
10. Pioli G, Giusti A, Barone A. Orthogeriatric care for the elderly with hip fractures: where are we? Aging Clin Exp Res, 2008, 20(2): 113-122.
11. Zuckerman JD, Sakales SR, Fabian DR, et al. Hip fractures in geriatric patients. Results of an interdisciplinary hospital care program. Clin Orthop Relat Res, 1992, (274): 213-225.
12. Antonelli Incalzi R, Gemma A, Capparella O, et al. Continuous geriatric care in orthopedic wards: a valuable alternative to orthogeriatric units. Aging (Milano), 1993, 5(3): 207-216.
13. Cogan L, Martin AJ, Kelly LA, et al. An audit of hip fracture services in the Mater Hospital Dublin 2001 compared with 2006. Ir J Med Sci, 2010, 179(1): 51-55.
14. Boyd RV, Hawthorne J, Wallace WA, et al. The Nottingham orthogeriatric unit after 1000 admissions. Injury, 1983, 15(3): 193-196.
15. 杨明辉, 吴新宝, 龚晓峰, 等. 骨科与老年科共管模式治疗老年髋部骨折及与英国的比较. 中国骨与关节杂志, 2017, 6(3): 169-173.
16. 吴新宝, 杨明辉, 张萍, 等. 老年病科和骨科共管模式缩短老年髋部骨折患者术前等待时间和住院时间. 骨科临床与研究杂志, 2017, 2(2): 96-100.
17. Pioli G, Davoli ML, Pellicciotti F, et al. Comprehensive care. Eur J Phys Rehabil Med, 2011, 47(2): 265-279.
18. Christie J, Macmillan M, Currie C, et al. Improving the experience of hip fracture care: A multidisciplinary collaborative approach to implementing evidence-based, person-centred practice. Int J Orthop Trauma Nurs, 2015, 19(1): 24-35.
19. Middleton M, Wan B, da Assunçao R. Improving hip fracture outcomes with integrated orthogeriatric care: a comparison between two accepted orthogeriatric models. Age Ageing, 2017, 46(3): 465-470.
20. Kristensen PK, Thillemann TM, Søballe K, et al. Can improved quality of care explain the success of orthogeriatric units? A population-based cohort study. Age Ageing, 2016, 45(1): 66-71.
21. 鲁攀攀, 马彬彬, 李荥娟, 等. 老年髋部骨折患者术前营养不良的危险因素分析. 中华老年骨科与康复电子杂志, 2018, 4(3): 145-150.
22. Bell JJ, Bauer JD, Capra S, et al. Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients-results of a pragmatic intervention. Clin Nutr, 2014, 33(6): 1101-1107.
23. Hoekstra JC, Goosen JH, de Wolf GS, et al. Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study. Clin Nutr, 2011, 30(4): 455-461.
24. Arshi A, Rezzadeh K, Stavrakis AI, et al. Standardized hospital-based care programs improve geriatric hip fracture outcomes: an analysis of the ACS NSQIP targeted hip fracture series. J Orthop Trauma, 2019, 33(6): e223-e228.
25. Deschodt M, Braes T, Broos P, et al. Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. J Am Geriatr Soc, 2011, 59(7): 1299-1308.
26. Folbert E, Smit R, van der Velde D, et al. Multidisciplinary integrated care pathway for elderly patients with hip fractures: implementation results from Centre for Geriatric Traumatology, Almelo, The Netherlands. Ned Tijdschr Geneeskd, 2011, 155(26): A3197.
27. Loizzo M, Gallo F, Caruso D. Reducing complications and overall healthcare costs of hip fracture management: a retrospective study on the application of a Diagnostic Therapeutic Pathway in the Cosenza General Hospital. Ann Ig, 2018, 30(3): 191-199.
28. Pioli G, Bendini C, Pignedoli P, et al. Orthogeriatric co-management-managing frailty as well as fragility. Injury, 2018, 49(8): 1398-1402.
29. Fernández-Ibáñez JM, Morales-Ballesteros MC, Crespo-Romero E, et al. Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain. Rev Esp Cir Ortop Traumatol, 2017, 61(2): 88-95.
30. Watne LO, Torbergsen AC, Conroy S, et al. The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Med, 2014, 12: 63.
31. Shyu YI, Liang J, Tseng MY, et al. Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture. J Gerontol A Biol Sci Med Sci, 2013, 68(2): 188-197.
32. Shyu YI, Tseng MY, Liang J, et al. Interdisciplinary intervention decreases cognitive impairment for older Taiwanese with hip fracture: 2-year follow-up. Int J Geriatr Psychiatry, 2013, 28(12): 1222-1231.
33. Deschodt M, Braes T, Flamaing J, et al. Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc, 2012, 60(4): 733-739.
34. Stenvall M, Berggren M, Lundström M, et al. A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia—subgroup analyses of a randomized controlled trial. Arch Gerontol Geriatr, 2012, 54(3): e284-e289.
35. Casey SD, Stevenson DE, Mumma BE, et al. Emergency department pain management following implementation of a geriatric hip fracture program. West J Emerg Med, 2017, 18(4): 585-591.
36. Miura LN, DiPiero AR, Homer LD. Effects of a geriatrician-led hip fracture program: improvements in clinical and economic outcomes. J Am Geriatr Soc, 2009, 57(1): 159-167.
37. Kates SL. Hip fracture programs: are they effective?. Injury, 2016, 47(Suppl 1): S25-S27.
38. Pedersen SJ, Borgbjerg FM, Schousboe B, et al. A comprehensive hip fracture program reduces complication rates and mortality. J Am Geriatr Soc, 2008, 56(10): 1831-1838.
39. Gregersen M, Mørch MM, Hougaard K, et al. Geriatric intervention in elderly patients with hip fracture in an orthopedic ward. J Inj Violence Res, 2012, 4(2): 45-51.
40. Collinge CA, McWilliam-Ross K, Beltran MJ, et al. Measures of clinical outcome before, during, and after implementation of a comprehensive geriatric hip fracture program: is there a learning curve? J Orthop Trauma, 2013, 27(12): 672-676.
41. Lau TW, Fang C, Leung F. The effectiveness of a multidisciplinary hip fracture care model in improving the clinical outcome and the average cost of manpower. Osteoporos Int, 2017, 28(3): 791-798.
42. Swart E, Vasudeva E, Makhni EC, et al. Dedicated perioperative hip fracture comanagement programs are cost-effective in high-volume centers: an economic analysis. Clin Orthop Relat Res, 2016, 474(1): 222-233.
43. 谢添, 马彬彬, 李荥娟, 等. 加速康复外科在老年髋部骨折的研究现状. 中国修复重建外科杂志, 2018, 32(8): 1038-1046.
44. 刘佳鑫, 陈力, 段鑫, 等. 术前早期下地活动对老年髋部骨折患者术后生活自理能力的影响. 中国修复重建外科杂志, 2019, 33(3): 318-322.

Chinese Journal of Reparative and Reconstructive Surgery

Research progress of multidisciplinary team co-management models for geriatric hip fracture treatment

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