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. 2021 Mar 10;5(3):e20.00231.
doi: 10.5435/JAAOSGlobal-D-20-00231.

Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists

Nidhi Rohatgi  1 , Yingjie Weng, Jessie Kittle, Neera Ahuja
Affiliations

Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists

Nidhi Rohatgi et al. J Am Acad Orthop Surg Glob Res Rev. .

Abstract

Background: Rotating medical consultants, hospitalists or geriatricians, are involved in the care of patients with hip fracture, often after medical complications have already occurred. In August 2012, we implemented a unique surgical comanagement (SCM) model in which the same Internal Medicine hospitalists are dedicated year-round to the orthopaedic surgery service. We examine whether this SCM model was associated with a decrease in medical complications, length of stay, and inpatient mortality in patients with hip fracture admitted at our institution, compared with the previous model.

Methods: We included 2,252 admissions to the orthopaedic surgery service with a hip fracture between 2009 and 2018 (757 pre-SCM and 1495 post-SCM). We adjusted for age, Charlson comorbidity score, and operating time in all regression analyses.

Results: Mean Charlson comorbidity score (1.6 versus 1.2) and median case mix index (2.1 versus 1.9) were higher in the post-SCM group. A 32% decrease was observed in the odds of having ≥1 medical complication(s) (odds ratio, 0.68 [95% confidence interval, 0.50 to 0.91], P = 0.009) post-SCM. No change was observed in length of stay or inpatient mortality despite an increase in medical complexity post-SCM.

Conclusion: Having dedicated orthopaedic hospitalists may contribute to fewer medical complications in patients with hip fracture.

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Figures

Figure 1
Figure 1
Graph showing the adjusted rate of ≥1 medical complication(s) by year before and after the implementation of SCM. The red line represents when SCM was implemented in August 2012. SCM = surgical comanagement
See this image and copyright information in PMC

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References

    1. Roberts KC, Brox WT, Jevsevar DS, Sevarino K: Management of hip fractures in the elderly. J Am Acad Orthop Surg 2015;23:131-137. - PubMed
    1. Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD: Surgical management of hip fractures: An evidence-based review of the literature. I: Femoral neck fractures. J Am Acad Orthop Surg 2008;16:596-607. - PubMed
    1. Brauer CA: Incidence and mortality of hip fractures in the United States. JAMA 2009;302:1573. - PMC - PubMed
    1. Grau L, Summers S, Massel DH, Rosas S, Ong A, Hernandez VH: Operative trends in the treatment of hip fractures and the role of arthroplasty. Geriatr Orthop Surg Rehabil 2018;9:215145931876063. - PMC - PubMed
    1. Endo A, Baer HJ, Nagao M, Weaver MJ: Prediction model of in-hospital mortality after hip fracture surgery. J Orthop Trauma 2018;32:34-38. - PubMed