Early orthogeriatric treatment of trauma in the elderly: A systematic review and metaanalysis

Background: More than 125 000 hip fractures occur in Germany every year, with a one-year mortality of about 25%. To improve treatment outcomes, models of cooperation between trauma surgery and geriatrics have been developed. Their benefit has not yet been unequivocally demonstrated. Methods: We systematically searched the Medline database and the Cochrane Library for prospective randomized controlled trials in which the treatment of elderly patients with fractures by the trauma surgery service alone was compared with preoperatively initiated collaborative treatment by the trauma surgery and geriatric services ("orthogeriatric" treatment). We investigated three treatment outcome variables-length of hospital stay, in-hospital mortality, and one-year mortality-in a metaanalysis. Results: The five trials of hip fracture treatment that met the selection criteria all had relatively small study populations and a high risk of bias. The outcomes with respect to hospital stay differed greatly among trials (I2: 88.5%), and geriatric intervention was not found to have any statistically significant effect (0.06 days, 95% confidence interval [CI]: -3.74 to 3.62 days). The relative risk of dying in the hospital was 0.66 for orthogeriatric treatment (95% CI: 0.28-1.55, p = 0.34), and the hazard ratio for one-year mortality was 0.79 in favor of orthogeriatric treatment (95% CI: 0.57 to 1.10, p = 0.17). A metaanalysis of functional outcomes was not possible. Conclusion: Only a few randomized controlled trials of early orthogeriatric treatment have been performed, and these trials are of limited quality. Due to low case numbers, a benefit from interdisciplinary orthogeriatric treatment could not clearly be demonstrated. Further trials are needed.