OBJECTIVES: To determine whether geriatric hip fractures can be managed effectively within a level 1 trauma center. DESIGN: A prospective observational cohort study with a historical control group. SETTING: Level 1 trauma center. PATIENTS: A total of 199 patients admitted under our hip fracture service were prospectively identified from 2011-2012. These were compared with 191 hip fracture patients who were admitted before the service. INTERVENTION: The hip fracture service includes coadmission under an orthopaedic and a geriatric team. A daily, consultant-led operating list was made available for hip fracture surgery. A "neck of femur" nurse was employed to coordinate patient care. MAIN OUTCOME MEASUREMENTS: Time to surgery, length of stay, discharge destination, and mortality. A cost-benefit analysis and a comparison with a lower acuity hospital were also performed. RESULTS: Since the hip fracture service, more patients underwent surgery within 48 hours (67% vs. 52%; P = 0.004), the length of stay significantly decreased from 26 to 22 days (P = 0.004), significantly more patients were admitted to the rehabilitation unit (58.7% vs. 3.5%; P < 0.001) and ultimately discharged to their own residence (51.6% vs. 40.5%; P = 0.034). Inpatient mortality rates did not change significantly (7.5% vs. 6.8%; P = 0.780). The estimated cost saving in 2011 was $981,040. CONCLUSIONS: Only minor changes are required to significantly improve the management of geriatric hip fracture patients. These patients can be managed effectively within a level 1 trauma center when an organized service prioritizing these patients is used. LEVEL OF EVIDENCE: Therapeutic level III. See Instructions for authors for a complete description of levels of evidence.
OBJECTIVES: To determine whether geriatric hip fractures can be managed effectively within a level 1 trauma center. DESIGN: A prospective observational cohort study with a historical control group. SETTING: Level 1 trauma center. PATIENTS: A total of 199 patients admitted under our hip fracture service were prospectively identified from 2011-2012. These were compared with 191 hip fracturepatients who were admitted before the service. INTERVENTION: The hip fracture service includes coadmission under an orthopaedic and a geriatric team. A daily, consultant-led operating list was made available for hip fracture surgery. A "neck of femur" nurse was employed to coordinate patient care. MAIN OUTCOME MEASUREMENTS: Time to surgery, length of stay, discharge destination, and mortality. A cost-benefit analysis and a comparison with a lower acuity hospital were also performed. RESULTS: Since the hip fracture service, more patients underwent surgery within 48 hours (67% vs. 52%; P = 0.004), the length of stay significantly decreased from 26 to 22 days (P = 0.004), significantly more patients were admitted to the rehabilitation unit (58.7% vs. 3.5%; P < 0.001) and ultimately discharged to their own residence (51.6% vs. 40.5%; P = 0.034). Inpatient mortality rates did not change significantly (7.5% vs. 6.8%; P = 0.780). The estimated cost saving in 2011 was $981,040. CONCLUSIONS: Only minor changes are required to significantly improve the management of geriatric hip fracturepatients. These patients can be managed effectively within a level 1 trauma center when an organized service prioritizing these patients is used. LEVEL OF EVIDENCE: Therapeutic level III. See Instructions for authors for a complete description of levels of evidence.
Authors: Jordan B Pasternack; Matthew L Ciminero; Michael Silver; Joseph Chang; Piyush Gupta; Kevin K Kang Journal: Geriatr Orthop Surg Rehabil Date: 2020-03-16