The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial Oslo Orthogeriatric TrialReport as inadecuate




The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial Oslo Orthogeriatric Trial - Download this document for free, or read online. Document in PDF available to download.

BMC Medicine

, 12:63

First Online: 15 April 2014Received: 28 January 2014Accepted: 17 March 2014DOI: 10.1186-1741-7015-12-63

Cite this article as: Watne, L.O., Torbergsen, A.C., Conroy, S. et al. BMC Med 2014 12: 63. doi:10.1186-1741-7015-12-63

Abstract

BackgroundDelirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia. The aim of this trial was to evaluate the effect of a pre- and postoperative orthogeriatric service on the prevention of delirium and longer-term cognitive decline.

MethodsThis was a single-center, prospective, randomized controlled trial in which patients with hip fracture were randomized to treatment in an acute geriatric ward or standard orthopedic ward. Inclusion and randomization took place in the Emergency Department at Oslo University hospital. The key intervention in the acute geriatric ward was Comprehensive Geriatric Assessment including daily interdisciplinary meetings. Primary outcome was cognitive function four months after surgery measured using a composite outcome incorporating the Clinical Dementia Rating Scale CDR and the 10 words learning and recalls tasks from the Consortium to Establish a Registry for Alzheimer’s Disease battery CERAD. Secondary outcomes were pre- and postoperative delirium, delirium severity and duration, mortality and mobility measured by the Short Physical Performance Battery SPPB. Patients were assessed four and twelve months after surgery by evaluators blind to allocation.

ResultsA total of 329 patients were included. There was no significant difference in cognitive function four months after surgery between patients treated in the acute geriatric and the orthopedic wards mean 54.7 versus 52.9, 95% confidence interval for the difference -5.9 to 9.5; P = 0.65. There was also no significant difference in delirium rates 49% versus 53%, P = 0.51 or four month mortality 17% versus 15%, P = 0.50 between the intervention and the control group. In a pre-planned sub-group analysis, participants living in their own home at baseline who were randomized to orthogeriatric care had better mobility four months after surgery compared with patients randomized to the orthopedic ward, measured with SPPB median 6 versus 4, 95% confidence interval for the median difference 0 to 2; P = 0.04.

ConclusionsPre- and postoperative orthogeriatric care given in an acute geriatric ward was not effective in reducing delirium or long-term cognitive impairment in patients with hip fracture. The intervention had, however, a positive effect on mobility in patients not admitted from nursing homes.

Trial registrationClinicalTrials.gov NCT01009268 Registered November 5, 2009

KeywordsHip fracture Orthogeriatrics Delirium Cognitive decline Electronic supplementary materialThe online version of this article doi:10.1186-1741-7015-12-63 contains supplementary material, which is available to authorized users.

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Author: Leiv Otto Watne - Anne Cathrine Torbergsen - Simon Conroy - Knut Engedal - Frede Frihagen - Geir Aasmund Hjorthaug - Vibe

Source: https://link.springer.com/







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