Abstract Background Although involvement of geriatricians in the care of older trauma patients is associated with changes in processes of care and improved outcomes, few geriatrician consultations ...were ordered on our service. Study Design Mandatory geriatric consults were initiated in Sept 2013 for all trauma patients 70 years and older admitted to our hospital. We prospectively collected data on patients admitted from Oct 2013–Sept 2014 (post-intervention) and compared to patients admitted from Jun 2011–Jun 2012 (pre-intervention). We collected data on processes of care (Do Not Resuscitate/ Do Not Intubate (DNR/DNI) status, delirium, referral for cognitive evaluation) and patient outcomes (mortality, readmission, length of stay). Descriptive statistics and post-hoc power analyses were performed. Results There were 215 and 191 patients included in the pre-intervention and post-intervention cohorts respectively. After the intervention, geriatric consults increased from 3.26% to 100%. Patients on DNR/DNI status increased from 10.23% to 38.22% ( P <0.01). Referral for formal cognitive evaluation increased from 2.33% to 14.21% ( P <0.01) and delirium documentation increased from 31.16% to 38.22% ( P= 0.14). In-hospital mortality and 30-day mortality in the pre- and post-intervention periods were 9.30% vs. 5.24% ( P =0.12) and 11.63% vs. 6.81% ( P =0.10) respectively. ICU readmission was 8.26% pre-intervention and 1.96% post-intervention ( P =0.06). There were no changes in 30-day hospital readmission and length of stay. Power analyses showed more patients were needed to show statistically significant outcomes. Conclusions The initiation of mandatory geriatric consults on our trauma service was associated with improved advance care planning and increased multidisciplinary care. Ensuring involvement of geriatricians may aid in reducing adverse outcomes among geriatric trauma patients.
Geriatric trauma continues to rise, corresponding with the continuing growth of the older population. These fractures continue to expand, demonstrated by the incidence of hip fractures having grown ...to 1.5 million adults worldwide per year. This patient population and their associated fracture patterns present unique challenges to the surgeon, as well as having a profound economic impact on the health care system. Pharmacologic treatment has focused on prevention, with aging adults having impaired fracture healing in addition to diminished bone mineral density. Intraoperatively, novel ideas to assess fracture reduction to facilitate decreased fracture collapse have recently been explored. Postoperatively, pharmacologic avenues have focused on future fracture prevention, while shared care models between geriatrics and orthopaedics have shown promise regarding decreasing mortality and length of stay. As geriatric trauma continues to grow, it is imperative that we look to optimize all phases of care, from preoperative to postoperative.
