gms | German Medical Science

German Congress of Orthopaedics and Traumatology (DKOU 2019)

22. - 25.10.2019, Berlin

Geriatric Fracture Center vs Usual Care – what are the benefits? Results of a large prospective multicenter cohort study

Meeting Abstract

  • presenting/speaker Michael Blauth - Medizinische Universität Innsbruck, Universitätsklinik f. Unfallchirurgie und Sporttraumatologie, Innsbruck, Austria
  • Alexander Joeris - AO Foundation, Dübendorf, Switzerland
  • Elke Rometsch - AO Foundation, Dübendorf, Switzerland
  • Kathrin Espinoza - AO Foundation, Dübendorf, Switzerland
  • Markus Gosch - Klinikum Nürnberg Nord, Klinik für Innere Medizin 2, Schwerpunkt Geriatrie, Nürnberg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocIN18-437

doi: 10.3205/19dkou705, urn:nbn:de:0183-19dkou7054

Published: October 22, 2019

© 2019 Blauth et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objectives: The number of older trauma patients is increasing rapidly. These patients have complex needs far beyond fracture care itself, so usual care is often deemed sub-optimal. Geriatric fracture centers (GFC) have been established to improve both quality and cost-effectiveness. The aim of this study was to compare outcomes of GFC and Usual Care Centers (UCC) after treatment of proximal femoral fractures in older patients.

Methods: Based on clearly defined parameters, 6 GFC and 6 UCC from 6 countries were selected and enrolled 281 patients ≥ 70 years. The primary outcome was the major adverse events (MAE) rate at 1 year. Secondary outcomes included mortality, mobility and in-hospital parameters.

Odds ratios (OR) with confidence intervals (CI) were calculated for individual MAE rates. A multivariable regression model was developed controlling for age, gender, Charlson Comorbidity Index (CCI), number of falls within 3 months before surgery, type of surgery and residential status at baseline. Changes of mobility over time were evaluated with a mixed effects model, which in addition to the aforementioned parameters controlled for the respective score at baseline. Mortality was analyzed with Kaplan-Meier curves and the log-rank test.

Results: The gender distribution was similar in GFC and UCC. The CCI was slightly imbalanced (p=0.001), with more patients of a CCI ≥ 3 in GFC.

The rate of patients with MAEs at 1 year was low (18.1%) but higher (p<0.001) in GFC (28.2%, 95%CI 20.9-36.3) than in UCC (7.9%, 95%CI 4.0-13.7). The rate of in-hospital MAEs was also higher in GFC, which was based on the occurrence of delirium (Table 1 [Tab. 1]).

In the multivariable analysis, treatment group (GFC vs. UCC) was the only factor (OR 4.08, 95% CI 1.87-8.88, P<0.001) with a significant effect on the MAE rate.

The median length of hospital stay until discharge from the orthopedic/trauma department was shorter (p<0.001) in GFC (7 nights, 95%CI 6-10) vs. UCC (12 nights, 95%CI 9-16). Also, the median time from hospital admission to surgery was shorter (p<0.001) in GFC (28 hours, 95%CI 19-40) vs. UCC (43 hours, 95%CI 22-92). Changes over time of both Parker Mobility Score (PMS) and the timed up-and-go test (TUG) were more favorable in GFC at 1 year (PMS: GFC 3.1, UCC 2.2, p<0.001; TUG: GFC -39s, UCC -31s, p=0.017) and for the TUG also at 12 weeks (GFC -31s, UCC -17s, p=0.003).

The overall mortality rate was low, with a 1 year survival rate of 85.2% (95%CI 78.0-90.2) for GFC and 88.5% (95%CI 81.7-92.9) for UCC (p=0.46).

Conclusion: Contrary to our expectation, the rate of MAEs was higher in GFC despite several favorable clinical and hospital parameters. It is unclear whether a better awareness of age-specific adverse events in GFC introduced a reporting bias, whether unknown risk factors were unequally distributed in the populations, or whether treatment quality in UCC has nowadays reached a standard equal to GFC. Overall MAE and mortality rates were lower than expected.