Evidence map›Paper›PMID 36609506›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2023

Nonoperative versus operative management of frail institutionalized older patients with a proximal femoral fracture: a cost-utility analysis alongside a multicenter prospective cohort study.

S A I Loggers, A J L M Geraerds, P Joosse, H C Willems, T Gosens, R Van Balen, C L P Van de Ree, K J Ponsen, J Steens, R G Zuurmond and 4 more

Erratum issuedOpen access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 14 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 1 pooled it
5.4field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Observational
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  7. Predictive ability of frailty scores in surgically managed patients with traumatic spinal injuries: a TQIP analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 6 institutions in 1 country.

S A I LoggersDepartment of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands.
A J L M GeraerdsDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
P JoosseDepartment of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands.
H C WillemsGeriatrics Section, Department of Internal Medicine, Amsterdam UMC Location AMC, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands.
T GosensDepartment of Orthopedic Surgery, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, the Netherlands.
R Van BalenDepartment of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
C L P Van de ReeDepartment Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, P.O. Box 90151, 5000 LC, Tilburg, the Netherlands.
K J PonsenDepartment of Surgery, Northwest Clinics Alkmaar, P.O Box 501, 1800 AM, Alkmaar, the Netherlands.
J SteensDepartment of Orthopedic Surgery, Dijklander Ziekenhuis, P.O. Box 600, 1620 AR, Hoorn, the Netherlands.
R G ZuurmondDepartment of Orthopedic Surgery, Isala, P.O. Box 10400, 8000 GK, Zwolle, the Netherlands.
M H J VerhofstadTrauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
S Polinder *Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
Esther M M Van Lieshout *Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands. e.vanlieshout@erasmusmc.nl.ORCID http://orcid.org/0000-0002-2597-7948
FRAIL-HIP study group
Erasmus MC · NLElisabeth-TweeSteden Ziekenhuis · NLRode Kruis Ziekenhuis · NLAmsterdam University Medical Centers · NLIsala · NLLeiden University Medical Center · NL

Funding

Osteosynthesis and Trauma Care Foundation 2019-PJKPZonMw 843004120
6 · The paper itself

Abstract

Hip fractures are associated with significant healthcare costs. In frail institutionalized patients, the costs of nonoperative management are less than operative management with comparable short-term quality of life. Nonoperative management of hip fractures in patients at the end of life should be openly discussed with SDM. PURPOSE: The aim was to describe healthcare use with associated costs and to determine cost-utility of nonoperative management (NOM) versus operative management (OM) of frail institutionalized older patients with a proximal femoral fracture.

methodsThis study included institutionalized patients with a limited life expectancy aged ≥ 70 years who sustained a proximal femoral fracture in the Netherlands. Costs of hospital- and nursing home care were calculated. Quality adjusted life years (QALY) were calculated based on EuroQol-5D-5L utility scores at day 7, 14, and 30 and at 3 and 6 months. The incremental cost-effectiveness ratio (ICER) was calculated from a societal perspective.

resultsOf the 172 enrolled patients, 88 (51%) patients opted for NOM and 84 (49%) for OM. NOM was associated with lower healthcare costs at 6 months (NOM; €2425 (SD 1.030), OM; €9325 (SD 4242), p < 0.001). The main cost driver was hospital stay (NOM; €738 (SD 841) and OM; €3140 (SD 2636)). The ICER per QALY gained in the OM versus NOM was €76,912 and exceeded the threshold of €20,000 per QALY. The gained QALY were minimal in the OM group in patients who died within 14- and 30-day post-injury, but OM resulted in more than triple the costs.

conclusionOM results in significant higher healthcare costs, mainly due to the length of hospital stay. For frail patients at the end of life, NOM of proximal femoral fractures should be openly discussed in SDM conversations due to the limited gain in QoL.

trial registrationNetherlands Trial Register (NTR7245; date 10-06-2018).

Indexed as

Proximal Femoral FracturesQuality of LifeAgedCost-Benefit AnalysisFrail ElderlyHumansProspective StudiesQuality-Adjusted Life YearsCost-utilityHealthcare costsHip fractureNonoperativeOperativeQuality of life

Identifiers

PMID36609506
PMCPMC9908658
OpenAlexW4313655865

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.