ผลลัพธ์ทางคลินิกของโครงการพัฒนาระบบร่วมกันระหว่างโรงพยาบาลศูนย์และโรงพยาบาลชุมชนในการดูแลระยะกลางหลังการผ่าตัดในผู้ป่วยกระดูกสะโพกหัก จังหวัดเชียงราย: การวิเคราะห์เบื้องต้น

Amornsak Roobsoong; Jiraporn Permyao; Sureeporn Chantiratikul

Authors

Amornsak Roobsoong Chiangrai Prachanukroh Hospital
Jiraporn Permyao Chiangrai Prachanukroh Hospital
Sureeporn Chantiratikul Chiangrai Prachanukroh Hospital

Keywords:

clinical outcomes, peritrochanteric fracture, intermediate postoperative care, elder, district hospitals

Abstract

Background & Rationale: The peritrochanteric hip fracture or hip fracture in an elder is one of the most fatal orthopedic trauma which needs surgical correction and appropriate rehabilitation after surgery until the patient can live an independent living. This condition causes a prolonged postoperative hospital stay, increases postoperative cost, crowds out other patients to limited hospital bed and overloads hospital workforces. The intermediate postoperative care project has been developed between the regional and district hospitals in Chiang Rai province to increase the capability of postoperative hip fracture care in district hospitals. The hip fractures patients after surgical treatment in Chiangrai Prachanukroh Hospital will be referred back to district hospitals for inpatient rehabilitation. This was the way to decrease the postoperative hospital stay and increase clinical outcomes in elderly with hip fractures in Chiang Rai province. Objective: The objective of this study was to compare the clinical outcomes of peritrochanteric hip fracture in the intermediate postoperative care project between the regional hospital and district hospitals in Chiang Rai province. Methodology: This study was a prospective cohort study recruiting hip fractures elderly patients who were assigned to intermediate postoperative care in Chiangrai Prachanukroh Hospital and district hospitals from February to June 2019. The population in this study covered 91 patients of two medical benefit schemes. There were 27 patients taken care in Chiangrai Prachanukroh Hospital and 64 patients taken care in district hospitals. Results: The average ages of the elderly patients with hip fractures taken care in Chiangrai Prachanukroh Hospital and district hospitals were 76.2 and 76.6 years respectively. Most of them (70.4 and 62.5 percent respectively) were suffered from the intertrochanteric area fractures. The percentages of the patients who were operated by the proximal femoral nail antirotation (PFNA) fixation were 59.3 and 64.1. The average length of postoperative hospital stay in Chiangrai Prachanukroh Hospital was statistically significant lowered from 5.4 to 3.5 days (p=0.001). There were no significant differences in postoperative complications (p=0.305). The activity of daily living scores (Barthel’s index) of the elderly patients on discharge date were 13.6 and 13.3, and at 6 weeks after discharge were at 17.0 and 17.2 respectively (p=0.874). Conclusion: The clinical outcomes of peritrochanteric hip fracture in the intermediate postoperative care project treated at the regional and district hospitals in Chiang Rai province were not different. The project lowered the average length of postoperative hospital stay in Chiangrai Prachanukroh Hospital.

References

Foundation of Thai Gerontology Research and Development Institute and Institute for Population and Social Research, Mahidol University. Situation of the Thai elderly. 1st printing. Bangkok: The National Elderly Committee; 2015. (in Thai)

Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ 1993;307 (6914):1248-50.

Cree M, Soskolne CL, Belseck E, Hornig J, McElhaney JE, Brant R, et al. Mortality and institutionalization following hip fracture. J Am Geriatr Soc 2000;48(3):283-8.

Johnell O, Kanis JA. An estimate of worldwide prevalence and disability associated with osteoporosis fractures. Osteoporos Int 2006;17(12):1726-33.

Rojanasthien S, Luevitoonvechkij S. Epidemiology of hip fracture in Chiang Mai. J Med Assoc Thai 2005;88(Suppl 5):S105-9.

Vaseenon T, Luevitoonvechkij S, Wongtriratanachai P, Rojanasthien S. Long-term mortality after osteoporotic hip fracture in Chiang Mai, Thailand. Journal of Clinical Densitometry 2010;13(1):63-7.

Chrichiiles EA, Butler CD, Davis CS, Wallace RB. A model of lifetime osteoporosis impact. Arch Intern Med 1991;151(10):2026-32.

Scaf-Klormp W, van Sonderen E, Sanderman R, Ormel J, Kempen GI. Recovery of physical function after limb injuries in independent older people living at home. Age Ageing 2001;30(3):213-9.

Wongwiwat N. Intermediate Care Model. The Management of Intermediate Care Model in Hospitals; 2018 May 1; Bangkok. (in Thai)

Department of Medical Service, Ministry of Public Health. Smart Intermediate Care [Internet]. 2017 [cited 2019 Apr 30]. Available from: http://bps.moph.go.th/new_bps/node/189. (in Thai)

Jordan KM, Cooper C. Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol 2002;16(5):795-806. doi: 10.1053/berh.2002.0264.

Tinetti ME Clinical practice. Preventing fall in elderly persons. N Engl J Med 2003;348(1):42-9. doi: 10.1056/NEJMcp020719.

Eren OT, Küzkkaya M, Tezer M, Yilmaz C, Kuzgun U. Treatment of intertrochanteric fractures of the femur with Ender nail in patient over the age of 65 years. Acta Orthop Traumatol Turc 2003;39(2):102-6.

Kesmezacar H, Ogut T, Bilgili MG, Gokay S, Tenekecioglu Y. Treatment of intertrochanteric femur fractures in elderly patients: internal fixation orhemiarthroplasty. Acta Orthop Traumatol Turc 2005;39(4):287-94.

Zhang YR, Rao F, Pi W, Zhang PX, Jiang BG. Proximal femoral nail antirotation and dynamic hip screws for fixation of unstable intertrochanteric fractures of femur: A meta-analysis. Beijing Da Xue Xue Bao Yi Xue Ban 2019;51(3):493-500.

Duymus TM, Aydogmus S, Ulusoy I, Kececi T, Adiyege L, Dernek B, et al. Comparison of Intra-and Extramedullary Implants in Treatment of Unstable Intertrochanteric Fractures. J Clin Orthop Trauma 2019;10(2):290-5.

Bottle A, Aylin P. Mortality associated with delay in operation after hip fracture: observational study. BMJ 2006;332(7547):947-51.

Chaysri R, Leerapun T, Klunklin K, Chiewchantanakit S, Leuvitoonvechakij S, Rojanasthien S. Factors related to mortality after osteoporotic hip fracture treatment at Chiang Mai University Hospital, Thailand during 2006 and 2007. J Med Assoc Thai 2015;98(1):59-64.

Pornkuna R. The Intermediate Care in Elders. The Elderly Service Plan; 2018 May 7-8; Khon Kaen. (in Thai)

Young J. The development of intermediate care services in England. Archives of Gerontology and Geriatrics 2009;49 Suppl 2:S21-5. doi: 10.1016/S0167-4943(09)70008-1.

Amphansap T, Nitiwarangkul L. One-year mortality rate after osteoporotic hip fractures and associated risk factors in Police General Hospital. Osteoporosis and Sarcopenia 2015;1:75-79.

Pils K1, Neumann F, Meisner W, Schano W, Vavrovsky GV, Van der Cammen TJ. Predictors of falls in elderly people during rehabilitation after hip fracture-who is at risk of a second one? Z Gerontol Geriatr 2003 Feb;36(1):16-22.

Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M. Complications of hip fractures: a review. World J Orthop 2014;5(4):402–11.