Nidhi Rohatgi1, Yingjie Weng, Jessie Kittle, Neera Ahuja. 1. From the Division of Hospital Medicine, Department of Medicine, Stanford University School of Medicine, CA (Dr. Rohatgi, Dr. Kittle, and Dr. Ahuja), and the Quantitative Sciences Unit, Division of Biomedical Informatics Research, Department of Medicine, Stanford University School of Medicine, CA (Mr. Weng).
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.
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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