Untersuchung des Einflusses von Depression, Demenz und postoperativen Delir auf die Länge der Hospitalisationsphase bei proximalen Femurfrakturen
Einleitung: Die geriatrische proximale Femurfraktur ist und bleibt in Deutschland mit jährlich fast 100.000 Fällen und jeweils durchschnittlichen Kosten von fast 9000€, eine große medizinische und sozioökonomische Belastung. Mit durchschnittlich 14 Tagen stationärem Aufenthalt und häufig darauffolg...
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Format: | Doctoral Thesis |
Language: | German |
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Philipps-Universität Marburg
2019
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Online Access: | PDF Full Text |
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Introduction: With almost 100,000 cases per year and an average cost of almost 9,000 € per patient, geriatric proximal femur fractures remain to be a major medical and socioeconomic burden in Germany. These injuries cause severe emotional and physical strains. This happens mainly due to the average length of inpatient stay of 14 days, the frequent and subsequent loss of autonomy as well as reduced motor functions. In this prospective study, the earliest medical discharge date was compared with the actual discharge date. Additionally, the influence of patient- and fracture-related factors, as well as dementia, depression and postoperative delirious symptoms on the earliest possible and the actual discharge time point were investigated. Methods: A total of 135 patients (99 female, 36 male) surgically treated within a twelve months period at the University Hospital Marburg, were included. The cognitive abilities were evaluated by the MMSE. Depressive and anxious symptoms were measured by applying the HADS-D. In addition to the daily documentation of general parameters, the earliest possible medical discharge was assessed. Results: A highly significant difference of 3.7 days (± 3.7, p = < 0.001) was identified by comparing the earliest possible medical date of discharge (10.7 days, ± 5.1) with the actual discharge date (14.4 days, ± 5.1). About 5.2 % of all patients showed complications requiring intervention after the earliest possible discharge date. In HADS-D, approximately 74 % of all patients revealed an inconspicuous result, 14 % a possible and 12 % a probable anxiety or depressive disorder. Only a slight correlation (0.215, p = 0.018) between HADS-D and the earliest possible discharge date was found. The MMSE showed an average score of 23.1. 39 % of the patients had no, 38 % had a slight and 23 % had a medium to severe cognitive impairment. With increasing age, a decreasing score in MMST and a decreasing difference between earliest possible and actual discharge time point, was determined. Furthermore, an increase in the relative frequency of inclusions or the transfers to a nursing home has been identified. A significant influence (0.177, p = 0.03) of the MMSE score and the fracture type AO B2 (0.217, p = 0.01) on the extension of the relative discharge time was depicted. Postoperative delirious symptoms were documented in 11 % of patients. Patients with corresponding symptoms were older with a mean age of 84.4 years and with a mean MMSE of 18.4 points, cognitively more restricted than the overall collective. Discussion : The comparison of the earliest possible with the actual discharge date showed a significant difference of 3.7 days. Applying MMSE and HADS-D revealed that a considerable number of patients suffered from cognitive impairment and/or possible anxiety and/or depressive disorder. The parameters investigated in this study could not be identified as sufficient factors for a relative prolongation of the residence time. Assuming that besides unknown factors, bureaucratic processes during the approval of a continuing stationary institution and the subsequent organization for the transfer in an appropriate facility are considerably for the relative prolongation of the in-patient time. In future studies, the duration and drains of these processes should be documented and examined, in order to clarify their influence on the length of the stay. As a consequence, the discharge management could be adjusted to be more efficiently and tailored to the individual needs of the patient. This could result in a reduction of stationary stay with associated costs and a reduced emotional burden for patients.