J Am Acad Orthop Surg Glob Res Rev. 2025 Dec 16;9(12). doi: 10.5435/JAAOSGlobal-D-25-00059. eCollection 2025 Dec 1.
ABSTRACT
INTRODUCTION: Proximal femoral fractures (PFFs) are a notable source of morbidity and mortality in elderly populations, with 1-year mortality rates ranging from 15% to 30% and projected incidence set to rise markedly. Interdisciplinary care models, including the integration of a nurse practitioner (NP), have shown the potential to improve outcomes in this vulnerable population.
METHODS: We held a retrospective cohort study to evaluate the impact of adding a geriatric NP to the orthopedic department on mortality and hospitalization outcomes in patients with PFFs. A total of 2,065 patients were included: 1,300 from the preintervention period (2017 to 2020) and 765 from the NP-intervention period (2021 to 2024).
RESULTS: Key outcomes revealed a notable reduction in in-hospital mortality from 5.6% to 2.4% (P = 0.0005) and an improvement in 1-year survival rates during the NP-intervention period. Kaplan-Meier analysis and Cox regression demonstrated a notable survival benefit with NP involvement, with average survival extending from 1.3 to 2.3 years (P < 0.001). The average length of stay decreased from 9.3 to 8.4 days (P = 0.003), and patient transfers to other departments were reduced by nearly one third.
CONCLUSION: These results highlight the positive effect of a geriatric NP on survival, hospital efficiency, and continuity of care for elderly PFF patients. The NP-led model, focusing on perioperative coordination, discharge planning, and comprehensive care, offers a promising approach to address the growing demand for geriatric fracture management, supporting its broader implementation to improve clinical and economic outcomes.
IMPLICATIONS FOR CLINICAL PRACTICE: Our findings support the adoption of geriatric-focused, NP-led interventions in orthopedic settings to optimize the care of elderly fracture patients, aligning with current trends in interdisciplinary approaches to geriatric health care. Expanding this model may improve outcomes on a larger scale, addressing the growing needs of an aging population while promoting high-quality, cost-effective care in geriatric fracture management.
PMID:41411485 | DOI:10.5435/JAAOSGlobal-D-25-00059
