PhD defence S.A.I. (Sverre) Loggers

Below is a brief summary of the dissertation: 

Decision making to operate or not to operate in the case of the frailest patients with a hip fracture is challenging. This thesis shows that that following the process of shared decision making in a subgroup of frail patients with a limited life expectancy, nonoperative management of hip fractures is a viable treatment option. Therefore, surgery in this specific group of patients should not be a foregone conclusion and surgical overtreatment needs to be prevented. In addition it shows that in these nursing home patients forgoing hospitalizing in patients with a suspected proximal femoral fracture with consequent nonoperative management is a feasible way of managing these patients that results in a high treatment satisfaction and humane quality of dying, with low adverse event rates and a predictable high short term mortality rate. Meanwhile it also shows that despite living independently, frail community-dwelling patients with a proximal femoral fracture have high risk of death, adverse events, and institutionalization. These patients should therefore be informed realistically about the postoperative course and chances of returning to their previous homes. In addition, early integration of palliative care could be necessary. These insights in the true outcomes of nonoperative- and operative management in the frailest patients with a proximal femoral fracture will aid in realistic expectation management, adequate shared decision making, and advance care planning. Ultimately this can lead to improved patient selection for nonoperative- and operative management and improve outcomes for these patients in the final phase of life.