Older Chinese patients with fragility hip fracture in Hong Kong: calling for focused ortho-geriatric co-care

Hon-Ming Ma, Qi Ding, Louis Wing-Hoi Cheung, Simon Kwoon-Ho Chow, Kwok-Sui Leung


Background: Orthogeriatric co-management is the standard of care of hip fracture.
Methods: This retrospective study aimed to evaluate the differences of clinical characteristics and outcomes of older patients (aged ≥50 years) hospitalised for hip fracture in six public hospitals in Hong Kong in 2012. They were categorized into three groups based on their need for peri-operative medical optimization: inputs from geriatricians (Group 1), inputs from general physicians (Group 2) and no need for medical inputs (Group 3). We compared their clinical characteristics, surgical treatment and short-term outcomes.
Results: In total, 2,748 patients were analyzed. Compared with patients of Group 3 (n=1,322), those of Group 1 (n=422) and 2 (n=1,004) were slightly older, less able to walk independently and more likely to have pressure ulcer on admission. They also had higher peri-operative risk (American Society of Anesthesiologist Grade ≥3) with a larger number of comorbidities. Group 3 had the largest proportion (72.7%) of patients who had early surgical treatment (<48 hours of admission), followed by Group 1 (59.5%) and Group 2 (48.1%). Patients of Group 3 had the lowest incidence of post-operative complications, in-hospital mortality, length of stay (LOS) in acute hospital and institutionalisation.
Conclusions: The demand for peri-operative medical optimization in older patients undergoing hip fracture surgery was very huge. We may re-engineer the existing service model in view of ageing population. Group 3 represented a distinct group of healthier patients who can be managed by a nurse-led approach.