Research Article: Do we need orthogeriatrics in Poland? Changes in the age structure and location of hip fractures

Date Published: September 6, 2016

Publisher: Springer International Publishing

Author(s): Robert Wilk, Michał Skrzypek, Małgorzata Kowalska, Damian Kusz, Bogdan Koczy, Piotr Zagórski, Wojciech Pluskiewicz.

http://doi.org/10.1007/s40520-016-0627-1

Abstract

Patients with hip fractures present a great challenge for surgeons due to multimorbidity, polypharmacy as well as difficulty in communicating. These could be attributed to a recent trend in the aging patient population (80 years and older) as compared to the past. The aim of this study is to analyze age structure and location in male and female patients’ population with hip fracture over 50.

Hospital records between 2005 and 2014 with ICD-10 codes S72,0, S72,1 and S72,2 were included in the analysis. All fractures occurred in citizen aged 50 years and over living in the district of Tarnowskie Góry and the city of Piekary Śląskie in Poland.

Within the study period, 1258 hip fractures were registered. The mean age of the patients was higher every year, starting from 77.27 ± 9.52 in 2005 to 80.80 ± 9.65 years in 2014 (p < 0.01). The average age also increased in both gender groups from 73.85 ± 8.30 to 77.89 ± 9.52 years in male and from 78.14 ± 9.66 to 81.98 ± 9.49 years in female, respectively. The median age value was changed from 78.00 to 83.00 years in the total population. We noted a significant increase in female with trochanteric fracture; however, the level of neck fracture was almost the same. In men, crude rates for both trochanteric and cervical fractures slightly increased. As the age of patients increases, fractures were shown to be more complicated. Given the scale of the phenomenon and its determinants, we emphatically conclude orthogeriatrics is needed in Poland.

Partial Text

Hip fracture is one of the most common osteoporotic fractures. Nowadays, we can say that it is a worldwide challenge [1]. Orthopedic surgeons who work at Orthopedic and Traumatology Departments operate daily on patients with hip fracture (both cervical and trochanteric). Patients with fragility hip fracture are usually a great challenge for surgeons because of multimorbidity and polypharmacy, as well as difficulty in communicating. Due to the aging population, there are more patients aged 80 and older than in the past. These patients need a multidisciplinary approach, starting with geriatric and orthopedic care [2]. This type of system is called orthogeriatrics. According to a prospective, randomized, controlled trial, patients treated at specials orthogeriatric departments have better outcomes compared with the usual orthopedic [3]. Although the aging of polish population is well known there were no studies that show the trend of age of patients with hip fractures in Poland [4].

The study covered the southern part of Poland, the district of Tarnowskie Góry and the city of Piekary Śląskie in Upper Silesia region. In 2014 (the last year of used for our observation), studied area was inhabited by 74947 residents aged 50 years and older (total population was 195,257 inhabitants, ~100 % of Caucasian population) [4]. Studied region composed of urban and rural dwellers in the proportion similar to the one of the total population of Poland. All patients (men and women) with musculoskeletal trauma are transported from the study area to Dr J. Daab Regional Hospital of Trauma Surgery in Piekary Śląskie. This is the only orthopedic hospital for the whole studied region so we may assume that almost all hip fractures sustained in the study population were managed in this institution. Case records of patients aged 50 years or older between the dates from January 1, 2005, and December 31, 2014, with code of the International Classification of Diseases ICD–10: S72,0 (cervical); S72,1 and S72,2 (intertrochanteric, subtrochanteric, inter and subtrochanteric fracture) were analyzed [5]. To assess the circumstances of the fall, we are based on anamnesis and the code ICD-10 (V01-Y98) of external causes of morbidity and mortality, and only fragility fractures (caused by the falls from a standing height or less) were included to analysis [5]. Other cases like: patients with address outside of studied area, and history of non low-energy fracture (e.g., car accident, falls from more than standing height) were excluded from the study. Each fracture was confirmed by an X-ray, and in justified cases a CT scan was performed. Cases of transfers to another hospital and readmission were identified. Records were analyzed to exclude duplicate records from the final data set. In order to confirm the goal of the study, we first calculated the crude rates for hip fracture per 100,000 population for the district of Tarnowskie Góry and city of Piekary Śląskie. Similarly, crude-specific rates were calculated for studied events in male and female population. Patients were divided into age groups as follows: 50–59; 60–69; 70–79; 80+ years. Our initial observation began in 2005 which also happens to be the year the Central Statistical Office of Poland published, for the first time official data for the oldest group (80+ years) [4].

In study period, there were 1258 patients with fragility hip fracture aged from 50 to 101 years. Mean age of subjects was 78.59 ± 10.34 years, while the median age was 80 years. Most of the study groups were women (n = 921; 73.21 % of subjects).

 

Source:

http://doi.org/10.1007/s40520-016-0627-1

 

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