Authors (including presenting author) :
Chan KW(1), Yip K(1), Ma HM(2) , Tang N(1), Ng WKR(3), Tso CY(1), Yau HT(2), Cheung HTH(2), Hui E(2), Siu HL(1), Wong CSK(1), Chan TJ (1)
Affiliation :
(1)Department of Orthopaedics and Traumatology, Prince of Wales Hospital , (2)Division of Geriatric Medicine , Department of Medicine and Therapeutics, Prince of Wales Hospital, (3) Department of Orthopaedics Rehabilitation, Tai Po Hospital
Introduction :
According to the international standard, patients presenting with fragility fracture should be considered for osteoporosis investigation and management. Fragility Liaison Service (FLS) has been introduced in Prince of Wales Hospital (PWH) since August 2019 for delivering a smooth patient journey with ortho-geriatric co-care and secondary fragility fracture prevention.
Objectives :
1. Evaluate the service outcome of FLS
2. Evaluate the result of secondary prevention of fragiligty fracture
Methodology :
Geriatric hip fracture patients who were admitted to acute orthopaedics ward at PWH would be managed by ortho-geri co-care model during hospitalization and follow up FLS in outpatient clinic. The mobility status and willingness of starting osteoporosis treatment would be assessed. Number of patients treated with surgery, pre-operative length of stay, 30-day and 1-year mortality rate, number of patient recruited for further osteoporosis management and suffering from another fragility fracture from August 2019 to July 2021 were evaluated.
Result & Outcome :
A total of 836 of geriatric patients were admitted to PWH for acute hip fracture from August 2019 to July 2021. Ninety-one percent (n=763) of patient received surgical treatment. Of them, 72% (n=553) of patient underwent operation within 2 days after admission. There were about 4.5% (n=38) and 19% (n=159) of patient died within 30-day and 1-year after hip fracture respectively. After reviewing the patients in clinic, 47% of patients (n=359) were recruited for osteoporosis management. Among these patients, 85% of patients (n=306) have been started on osteoporosis treatment and 3.6% of patient (n=13) sustained second fragility fracture within 1 year.
Discussion
Orthogeriatric co-care provided medical optimization which improved time to surgery and 30-day mortality. Patients with fragility hip fracture should receive bone protective medications after surgery. A variety of reasons, including treatment duration, logistic issue and decline in general condition, were identified for declining further osteoporosis management.
Conclusion
FLS is effective for enhancing smooth patient journey and promotion of osteoporosis treatment in geriatric hip fracture patient.
