Effects of an Integrated Geriatric-Orthopedic Co-management (InGerO) on the Treatment of Older Orthopedic Patients with Native and Periprosthetic Joint Infections

Abstract

Purpose

In view of our aging society, co-management with a geriatrician is becoming increasingly important. While such collaborations have been working successfully in trauma surgery for years, it is still unclear whether they are also helpful for non-trauma patients in orthopedics. The aim of this study was to investigate the effect of such a cooperation in orthopedic non-trauma patients with native and periprosthetic joint infections on the basis of five key areas.

Methods

A retrospective observational study as a before and after comparison was used to compare routine data from patients with and without orthogeriatric co-management after nontraumatic surgery. Eligible patients for the study were 70 years and older, had a diagnosis of hip, knee, or shoulder infection, and had been hospitalized for at least 14 days. Co-management consisted of close follow-up by a geriatrician, Comprehensive Geriatric Assessment, and “complex early geriatric rehabilitation”. The comparison group received therapy as usual, without a geriatrician and without “complex early geriatric rehabilitation”. Special attention was paid to delirium, pain, mobility, postoperative complications, and renal function.

Results

Analysis was carried out with 59 patients “with” and 63 “without” geriatric co-management. In the co-management group, delirium was detected significantly more often (p < 0.001), significantly lower pain intensities were measured at the time of discharge (p < 0.001), transfer ability had clearly improved more (p = 0.04), and renal function was more frequently noted (p = 0.04). No significant differences were found with respect to principal diagnoses, surgical procedures performed, complication rates, pressure ulcer and delirium incidence, operative revisions, or length of inpatient stay.

Conclusion

Orthogeriatric co-management in orthopedic patients with native and periprosthetic joint infections and nontraumatic surgery appears to have positive impacts on recognition and treatment of delirium, pain management, transfer performance, and attention to renal function. Further studies should follow in order to conclusively assess the value of such co-management in orthopedic nontraumatic surgery patients.

Zusammenfassung

Ziel

Angesichts einer alternden Gesellschaft gewinnt ein geriatrisches Co-Management zunehmend an Bedeutung. Während solche Kooperationen in der Unfallchirurgie seit Jahren erfolgreich funktionieren, ist noch unklar, ob sie auch für nicht-traumatische Patienten in der Orthopädie hilfreich sind. Ziel der Studie war es, die Wirkung einer solchen Zusammenarbeit bei orthopädischen Nicht-Trauma-Patienten mit nativen und periprothetischen Gelenkinfektionen anhand von 5 Schlüsselbereichen zu untersuchen.

Methoden

In einer retrospektiven Beobachtungsstudie als Vorher-nachher-Vergleich wurden Routinedaten von Patienten mit und ohne orthogeriatrisches Co-Management nach nicht traumatischer Operation verglichen. Für die Studie kamen Patienten infrage, die 70 Jahre und älter waren, bei denen eine Hüft-, Knie- oder Schulterinfektion diagnostiziert worden war und die mindestens 14 Tage im Krankenhaus verbracht hatten. Das Co-Management umfasste eine engmaschige Nachsorge durch einen Geriater, ein umfassendes geriatrisches Assessment und eine „komplexe geriatrische Frührehabilitation“. Die Vergleichsgruppe erhielt die übliche Therapie ohne einen Geriater und ohne „komplexe geriatrische Frührehabilitation“. Besonderes Augenmerk wurde auf Delirium, Schmerzen, Mobilität, postoperative Komplikationen und Nierenfunktion gelegt.

Ergebnisse

Die Analyse erfolgte bei 59 Patienten „mit“ und 63 „ohne geriatrisches Co-Management“. In der Co-Management-Gruppe wurde signifikant häufiger ein Delirium festgestellt (p < 0,001), es wurden signifikant geringere Schmerzintensitäten zum Entlassungszeitpunkt gemessen (p < 0,001), die Transferfähigkeit wurde deutlicher verbessert (p = 0,04) und die Einschränkung einer Nierenfunktion wurde häufiger beachtet (p = 0,04). Keine signifikanten Unterschiede fanden sich hinsichtlich der Hauptdiagnosen, der durchgeführten chirurgischen Prozeduren, der Komplikationsrate, Dekubitus- und Delirhäufigkeit, der operativen Revisionen oder der Dauer des stationären Aufenthaltes.

Schlussfolgerung

Orthogeriatrisches Co-Management bei orthopädischen Patienten mit nativen und periprothetischen Gelenkinfektionen und nicht traumatischen Eingriffen scheint positive Auswirkungen auf die Feststellung und Behandlung eines Delirs, auf das Schmerzmanagement, die Transferleistung und Beachtung der Nierenfunktion zu haben. Weitere Studien sollten folgen, um den Wert eines solchen Co-Managements bei orthopädischen Nicht-Trauma-Patienten abschließend zu bewerten.

Keywords

geriatric - orthopedic - co-management - non-trauma surgery - effects

Schlüsselwörter

geriatrisch - orthopädisch - Co-Management - Nicht-Trauma-Patienten - Effekte

Publication History

Received: 26 January 2022

Accepted after revision: 17 February 2023

Article published online:
21 April 2023

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