Table 4.
Complication rates
| Studies | Care model | Type of complication | Intervention N (%) with complications | Control N (%) with complications | p value |
|---|---|---|---|---|---|
| Baroni et al. [32] | GCS | In-hospital complicationsa: ACS, arrhythmia, syncope, PE, stroke, MI, pneumonia, GI or other major bleeding, CHF, respiratory failure, acute renal failure, delirium, bed sore, UTI, DVT, wound infection, dysphagia, uncontrolled pain, vomiting, hypotension, electrolyte imbalance | 99 (24.2%) | 159 (38.8%) | NS |
| ICM | 85 (20.8%) | 159 (38.8%) | < 0.05 | ||
| Biber et al. [43] | ICM | Surgical complications: arthroplasty dislocation, hematoma or seroma, infection, other complication requiring revision surgery | 9.6% | 7.7% | 0.6 |
| Boddaert et al. [33] | ICM |
Delirium Swallowing disorders Blood transfusion Stool impaction Urinary retention Pressure ulcer Acute heart failure Infection Venous thromboembolism Falls Admission to ICU |
72 (35%) 56 (28%) 141 (69%) 83 (41%) 57 (28%) 18 (9%) 33 (16%) 40 (20%) 10 (5%) 9 (4%) 8 (4%) |
49 (41%) 8 (7%) 72 (55%) 23 (19%) 26 (22%) 40 (33%) 6 (5%) 31 (25%) 1 (1%) 9 (7%) 17 (13%) |
0.29 < 0.001 0.008 < 0.001 0.24 < 0.001 0.002 0.27 0.06 0.32 0.005 |
| Deschodt et al. [28] | GCS | Postoperative delirium | 35 (37.2%) | 41 (53.2%) | 0.04 |
| Duaso et al. [35] | ICM |
Anemia/transfusion Respiratory complication Cardiological complication Infectious complication |
151 (40.7%) 15 (4.0%) 31 (8.4%) 13 (3.5%) |
254 (60.3%) 29 (6.9%) 48 (11.4%) 32 (7.6%) |
< 0.001 0.143 0.298 0.027 |
| Fisher et al. [36] | GCS |
Delirium Medical complicationsa: sepsis, delirium, pneumonia, venous thromboembolism, pressure sores, UTI, anemia, GI bleeding, ACS, CVA |
5.9% 49.5% |
11.7% 71.0% |
0.020 < 0.001 |
| Folbert et al. [37] | ICM |
Delirium Medical & surgical complicationsb: UTI, urinary retention, wound infection, pneumonia, CHF, MI, osteosynthesis failure, renal failure, hypervolemia, electrolyte imbalance, anemia, nerve injury, pressure sore |
54 (39%) Median (IQR) per patient: 0 (0–1) |
30 (33%) Median (IQR) per patient: 1 (0–2) |
0.421 0.017 |
| Folbert et al. [38] | ICM |
Medical & surgical complicationsa: -Medical: delirium, anemia, UTI, pneumonia, CHF, arrhythmia, renal failure, hypoxemia, MI, CVA, PE, other -Surgical: wound infection, dislocation implant, failure implant, re-intervention |
454 (53.4%) | 358 (66.9%) | < 0.001 |
| Frenkel et al. [44] | GW |
Delirium Medical complicationsa: UTI, urinary retention, acute renal failure, pneumonia, CHF, MI, CVA, delirium, PE, atrial fibrillation, SIRS, COPD exacerbation, other Orthopedic complications: wound infection, dislocation, per-prostatic fracture, reoperation |
6 (5.2%) N (SD): 1 (1.2) per pt 12 (10.3) |
5 (4.9%) N (SD): 0.6 (1) per pt 10 (9.8) |
1.0 0.029 1.0 |
| Friedman 2009 [45] | ICM |
Delirium Medical & surgical complicationsa: renal failure, delirium, hypoxia, pneumonia, CHF, CVA, MI, surgical site infection, UTI, DVT, PE, hemorrhagic stroke, intracranial or retroperitoneal bleeding, GI bleeding, another fracture, implant dislocation, periprosthetic fracture, arrhythmia |
24.4% 30.6% |
32.2% 46.3% |
0.13 0.005 |
| Kusen et al. [39] | ICM |
Delirium Medical & surgical complicationsa: -Medical: pneumonia, delirium, UTI, CHF, decubital ulcer, CVA, PE, renal insufficiency, reanimation, GI bleeding -Surgical: wound infection, hematoma, anemia, loss of reduction, screw cut-out/through, nail breakage, loss of fixation, joint infection |
22 (13.1%) 89 (53.0%) |
3 (1.9%) 85 (55.2%) |
< 0.001 0.69 |
| Leung et al. [47] | GCS | Postoperative complications | 154 (55.4%) | 155 (57.4%) | 0.54 |
| Lundström et al. [20] | GW |
Anemia Constipation Pressure ulcer Delirium Heart failure Pneumonia Urinary infection Myocardial infarction Nutritional complications Pulmonary embolism Stroke Urinary retention Falls |
88 (86.3%) 38 (37.3%) 9 (8.8%) 56 (54.9%) 6 (5.9%) 5 (4.9%) 32 (31.4%) 2 (2.0%) 25 (24.5%) 2 (2.0%) 0 16 (15.7%) 12 (11.8%) |
79 (82.3%) 47 (48.5%) 21 (22.1%) 73 (75.3%) 11 (11.6%) 3 (3.1%) 49 (51.0%) 4 (4.1%) 37 (38.1%) 0 1 (1.0%) 18 (18.6%) 26 (26.8%) |
0.441 0.110 0.010 0.03 0.161 0.772 0.005 0.436 0.038 0.498 0.485 0.591 0.006 |
| Marcantonio et al. [17] | GCS | Delirium | 20 (32%) | 32 (50%) | 0.04 |
| Reguant et al. [41] | ICM |
Delirium Medical & surgical complicationsa: cardiovascular, respiratory, secondary to spinal anesthesia, severe bleeding, renal, infections, re-intervention, cognitive disorders |
62 (22.8%) 183 (67.3%) |
66 (27.5%) 183 (76.2%) |
0.220 0.025 |
| Vidan et al. [25] | ICM |
Delirium Medical complicationsa: delirium, CHF, pneumonia, DVT, PE, pressure ulcers, arrhythmia, MI |
53 (34.2%) 70 (45.2%) |
67 (44.1%) 100 (61.7%) |
0.07 0.003 |
| Watne et al. [22] | GW |
Delirium Medical complicationsb: cardiac, cerebral, thrombo-embolic, pulmonary, GI, renal failure, UTI, pressure ulcer Surgical complications: surgical site infection, wound problem, osteosynthesis failure, dislocation of prosthesis |
80 (49%) 72 (44%) 4 (3%) |
86 (53%) 76 (46%) 6 (4%) |
0.51 0.82 0.75 |
| Werner et al. [51] | GCS |
Delirium Medical & surgical complicationsb pressure sores, UTI, acute kidney injury, GI bleeding, ileus, pneumonia, MI, PE, DVT, CVA, implant failure or luxation, wound infection |
41 (39.4%) 26 (25.0%) |
42 (40.8%) 25 (24.3%) |
0.888 > 0.99 |
Bold values denote statistical significance at the p < 0.05 level
GW geriatric ward, GCS geriatric consultant service, ICM integrated care model, aincluding delirium, bexcluding delirium, ACS acute coronary syndrome, CVA cerebrovascular accident, CHF congestive heart failure, DVT deep venous thrombosis, GI gastrointestinal, MI myocardial infarction, pt patient, PE pulmonary embolism, SIRS systemic inflammatory response syndrome, UTI urinary tract infection