• Kilian Rapp, Clemens Becker, Chris Todd, Dietrich Rothenbacher, Claudia Schulz, Hans-Helmut König, Ulrich Liener, Erich Hartwig, and Gisela Büchele.
• Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart; School of Health Sciences, University of Manchester, and Manchester Academic Health Sciences Centre, and Manchester University NHS Foundation Trust, Manchester, UK; Institute of Epidemiology and Medical Biom etry, Ulm University, Ulm; Center for Trauma Research, Ulm University, Ulm; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Orthopedics and Trauma Surgery, Marienhospital, Stuttgart; Department of Orthopedics and Trauma Surgery, Diakonissen Hospital Karlsruhe-Rüppurr, Karlsruhe.
• Dtsch Arztebl Int. 2020 Jan 24; 117 (4): 53-59.

BackgroundTo meet the special needs of older patients with fragility fractures, models for collaborative orthogeriatric care have been developed. The objective of our study was to analyze the association of orthogeriatric co-management with mortality following hip fracture in older patients in Germany.MethodsThis observational study was based on health insurance claims data from 58 001 patients (79.4% women) aged ≥80 years admitted to the hospital with hip fracture between January 2014 and March 2016. They were treated in 828 German hospitals with or without orthogeriatric co-management. The outcome measure was cumulative mortality with adjustment of the regression analyses.ResultsThe crude 30-day mortality was 10.3% for patients from hospitals with orthogeriatric co-management and 13.4% for patients from hospitals without orthogeriatric co-management. The adjusted 30-day mortality was 22% lower for patients in hospitals with orthogeriatric co-management (rate ratio 0.78; 95% CI [0.74; 0.82]; adjusted absolute difference -2.48%; 95% CI [-2.98; -1.98]). The difference in 30-day mortality remained nearly unchanged over the first 6 months. The risk reduction with orthogeriatric co-management was consistently observed in both women and men, across age groups, and in patients with and without care needs. The mean length of the index stay was 19.8 days in hospitals with orthogeriatric co-management and 14.4 days in hospitals without orthogeriatric co-management.ConclusionA multidisciplinary orthogeriatric approach is associated with lower mortality and a longer index stay in hospital after hip fracture.

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