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The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)
Watne LO, Torbergsen AC, Conroy S, Engedal K, Frihagen F, Hjorthaug GA, Juliebo V, Raeder J et al.. BMC medicine, 2014-04-15
Topic: Risk, prevention and care in population studies
Background Delirium 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. Methods This 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. Results A 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). Conclusions Pre- 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 registration ClinicalTrials.gov NCT01009268 Registered November 5, 2009.
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APA 7th
Watne, L. O., Torbergsen, A. C., Conroy, S., Engedal, K., Frihagen, F., Hjorthaug, G. A., et al. (2014). The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC medicine. https://doi.org/10.1186/1741-7015-12-63
Vancouver
Watne LO, Torbergsen AC, Conroy S, Engedal K, Frihagen F, Hjorthaug GA, 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 medicine. 2014. doi:10.1186/1741-7015-12-63. PMID: 24735588.
BibTeX
@article{watne2014-24735588,
author = {Watne, L. O. and Torbergsen, A. C. and Conroy, S. and Engedal, K. and Frihagen, F. and Hjorthaug, G. A. and Juliebo, V. and Raeder, J. and others},
title = {{The effect of a pre- and postoperative orthogeriatric service on cognitive function in patients with hip fracture: randomized controlled trial (Oslo Orthogeriatric Trial)}},
journal = {BMC medicine},
year = {2014},
doi = {10.1186/1741-7015-12-63},
pmid = {24735588},
url = {https://doi.org/10.1186/1741-7015-12-63}
}
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Key findings
- Background Delirium is a common complication in patients with hip fractures and is associated with an increased risk of subsequent dementia.
- Results A 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).
Why it matters
In this randomized controlled trial of 329 hip fracture patients, a pre- and postoperative orthogeriatric service produced no significant difference in cognitive function four months after surgery compared with standard orthopedic care. There was also no significant difference in delirium rates, so the intervention did not prevent delirium or longer-term cognitive decline in this trial.
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Study details
- Study designrandomized controlled trial
- Participants329
- Evidence strengthHigh
How this study scored 68/100
Published in a peer-reviewed journal, and it is a randomized controlled trial. Scored zero for effect reported because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BMC medicine) |
| Journal's citation record | 3 / 4 | BMC Medicine: journal h-index 259 (OpenAlex, 2026-10-29) |
| Study design | 11 / 12 | A randomized controlled trial |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2014 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 329 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 1 / 2 | Randomized (as stated in the record) |
| Times cited | 5 / 7 | Cited 177 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 12.6 citations a year over 14 year(s) since 2014 |
| Impact for its field and year | 4 / 6 | Cited 17.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 27 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Torgeir Bruun Wyller: h-index 58 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Oslo: institution h-index 1,024 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 6 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 24735588) |
| Free to read | 2 / 2 | Free to read |
| Total | 68 / 100 | — |
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