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. 2016 Feb;30(2):95-9.
doi: 10.1097/BOT.0000000000000440.

Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient's Hospital Length of Stay?

Sarah E Greenberg  1 , Jacob P VanHouten, Nikita Lakomkin, Jesse Ehrenfeld, Amir Alex Jahangir, Robert H Boyce, William T Obremksey, Manish K Sethi
Affiliations

Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient's Hospital Length of Stay?

Sarah E Greenberg et al. J Orthop Trauma. 2016 Feb.

Abstract

Objectives: The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient.

Design: Retrospective.

Setting: Urban level 1 trauma center.

Patients/participants: Six hundred fourteen geriatric hip fracture patients from 2000 to 2009.

Interventions: Orthopaedic surgery for geriatric hip fracture.

Main outcome measurements: Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service.

Results: Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients.

Conclusions: This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient's expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient's expected LOS.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The remaining authors report no conflict of interest.

Figures

FIGURE 1
FIGURE 1
Multivariate analysis of LOS for patients admitted to medicine versus orthopaedics. Editor’s note: A color image accompanies the online version of this article.
See this image and copyright information in PMC

Comment in

  • To the Editor.
    Metcalfe D, Weaver MJ, Harris MB. Metcalfe D, et al. J Orthop Trauma. 2016 Mar;30(3):e110. doi: 10.1097/BOT.0000000000000529. J Orthop Trauma. 2016. PMID: 26894641 No abstract available.
  • In response.
    Greenberg SE, Lakomkin N, VanHouten JP, Sethi MK. Greenberg SE, et al. J Orthop Trauma. 2016 Mar;30(3):e110. doi: 10.1097/01.bot.0000481120.63968.7f. J Orthop Trauma. 2016. PMID: 26894642 No abstract available.

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