ArticleActa orthopaedica2025
Satisfaction and quality of dying with nonoperative end-of-life care for hospitalized and non-hospitalized frail older patients with (suspected) hip fractures: a combined cohort study.
Article in Acta orthopaedica, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- An Acta Orthopaedica educational article: Femoral neck fractures in adults with emphasis on surgical treatment.Acta orthopaedica · 2025Review
- Nonoperative hip fracture care: how conservative should we be?Acta orthopaedica · 2025Article
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5 authors.
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Abstract
background and purposeFor frail institutionalized hip fracture patients who opt for nonoperative management (NOM), the additional treatment benefits of hospital admission and in-hospital diagnostics are not well evaluated. We aimed to describe and compare treatment satisfaction and quality of dying for patients who refrained from hospitalization after a hip fracture and patients who were treated nonoperatively after a short period of hospitalization.
methodsBoth cohorts included very frail institutionalized hip fracture patients. The first group directly started supportive care in their own nursing home after a suspected hip fracture. The second opted for NOM during shared decision-making after admission and diagnostics at the hospital. Primary outcomes were treatment satisfaction and quality of dying measured by the Quality of Dying and Death Questionnaire (QODD). Secondary outcomes included health-related quality of life (EuroQoL-5D-5L and Qualidem), pain, and medication.
results20 non-hospitalized and 88 hospitalized patients were included. Overall treatment satisfaction by proxies was high for both the non-hospitalized 9 (interquartile range [IQR] 8-10) and hospitalized patients 8 (IQR 4-9). Quality of dying was rated higher in the non-hospitalized group with QODD 8.3, IQR 6.9-8.6 versus 7.0, IQR 5.7-7.8, and median difference 1.0 (95% confidence interval [CI] 0.1-1.8). Health-related quality of life, measured by the EQ-5D-5L utility score, was low in both groups but higher in non-hospitalized patients (0.30, IQR 0.15-0.32) than in hospitalized patients (0.25, IQR 0.03-0.32, median difference: 0.03, CI -0.03 to 0.09). Both groups reported similar pain levels, but hospitalized patients used higher standardized daily doses of opiates (68 mg vs 39 mg, median difference 24 mg, CI 7-42).
conclusionProxies of hospitalized and non-hospitalized patients report high treatment satisfaction after opting for NOM. Non-hospitalization may have a beneficial effect on quality of dying in selected patients who have pre-recorded do-not-hospitalize directives or shared decision-making after a suspected hip fracture.
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