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Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture
van der Zwaard BC, Stein CE, Bootsma JEM, van Geffen HJAA, Douw CM, Keijsers CJPW.. Archives of orthopaedic and trauma surgery, 2019-10-29
Topic: Risk, prevention and care in population studies
Introduction Geriatricians have been increasingly involved in the pre-operative process in frail elderly patients with a hip fracture which can benefit re-hospitalization, post-operative functional performance, and mortality. The objective of this study was to compare the number of older patients with hip fractures who opted for non-surgical management after the addition of pre-operative comprehensive geriatric assessment (CGA) with shared decision making by a geriatrician to usual care. Secondary objectives were: reasons for non-surgical management, duration of life, and location of death. Materials and methods A single-center, with a level 2 trauma center, retrospective study comparing care before and after introducing pre-operative CGA with shared decision making in September 2014. Patients ≥ 70 years with a hip fracture, admitted from January 2014 to September 2015, were included. The percentages of patients elected for non-surgical management and palliative care without or with CGA were compared. Differences in secondary objectives (age, sex, medical history, medication use, functional, and social status) were compared descriptively and qualitatively. Results With pre-operative CGA significantly more patients (or representatives) elected the non-surgical management option after hip fracture (respectively, 9.1% vs 2.7%, p = 0.008). Patient characteristics were comparable. Reported reasons not to undergo surgery include aversion to be more dependent on others, and severe dementia. Conclusion The geriatrician can have an important role in decisions for non-surgical management by shared decision making in the pre-operative period in patients ≥ 70 years with a hip fracture in the emergency room.
Key findings
- Results With pre-operative CGA significantly more patients (or representatives) elected the non-surgical management option after hip fracture (respectively, 9.1% vs 2.7%, p = 0.008).
Study details
- Effect size9.1%; 2.7%
- Evidence strengthLow
How this study scored 41/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 24 of the 58 points we could judge it on, which is 41 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Archives of orthopaedic and trauma surgery) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 31664575) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 24 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 24 of the 58 points we could judge it on is 41 out of 100. |
| Total | 41 / 100 | — |
What each of these 20 components measures, and what this score is not →
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APA 7th
van der Zwaard, B. C., Stein, C. E., Bootsma, J. E. M., van Geffen, H. J. A. A., Douw, C. M., & Keijsers, C. J. P. W. (2020). Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture. Archives of orthopaedic and trauma surgery. https://doi.org/10.1007/s00402-019-03294-5
Vancouver
van der Zwaard BC, Stein CE, Bootsma JEM, van Geffen HJAA, Douw CM, Keijsers CJPW. Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture. Archives of orthopaedic and trauma surgery. 2020. doi:10.1007/s00402-019-03294-5. PMID: 31664575.
BibTeX
@article{vanderzwaard2020-31664575,
author = {van der Zwaard, B. C. and Stein, C. E. and Bootsma, J. E. M. and van Geffen, H. J. A. A. and Douw, C. M. and Keijsers, C. J. P. W.},
title = {{Fewer patients undergo surgery when adding a comprehensive geriatric assessment in older patients with a hip fracture}},
journal = {Archives of orthopaedic and trauma surgery},
year = {2020},
doi = {10.1007/s00402-019-03294-5},
pmid = {31664575},
url = {https://doi.org/10.1007/s00402-019-03294-5}
}