Admission service associated with outcomes after geriatric hip fracture surgery

A retrospective cohort study of 443 adults aged 65 or older at one urban safety-net hospital compared outcomes after hip fracture surgery by admitting service. Internal medicine admission was associated with higher one-year mortality, more surgical delays, longer hospital stays and less timely follow-up than orthogeriatric co-management.

Cohort included 443 surgically treated patients aged 65 or older.
Internal medicine admission was associated with higher one-year mortality.
Surgical delays, length of stay and follow-up also differed.
Single-center retrospective findings do not establish causality.

Researchers conducted a retrospective cohort study of 443 patients aged 65 or older who underwent operative treatment for hip fracture at an urban academic safety-net hospital from 2019 to 2022. Of these, 349 received orthogeriatric co-management and 94 were admitted to internal medicine without formal geriatric involvement. The study compared mortality, surgical timing, length of stay and follow-up; analyses included adjustment for selected factors and a matched analysis of 91 patient pairs.

Internal medicine admission was associated with higher one-year mortality (adjusted odds ratio 2.66, 95% CI 1.32–5.25) and greater odds of surgery being delayed beyond 24 hours (OR 3.16, 95% CI 1.98–5.12). These patients also had longer hospital stays and were less likely to have follow-up within three weeks. The associations persisted in the matched analysis.

The findings suggest that outcomes may differ by admitting service even where orthogeriatric care is available, and support consistent hip-fracture pathways across services. However, this was a retrospective, single-center study; unmeasured differences and residual confounding mean it cannot establish that the admitting service caused the outcome differences or that the results will generalize to other hospitals.

In practice

For hospitals caring for older adults undergoing hip fracture surgery, this single-center study found that internal medicine admission without formal geriatric involvement was associated with higher one-year mortality, more delays to surgery, longer stays and less timely follow-up than orthogeriatric co-management. The results support considering consistent perioperative hip-fracture pathways across admitting services, but they do not show that the admitting service caused these differences. Retrospective design, possible residual confounding and the single-site setting limit the evidence; the study alone does not establish a change in standard practice.

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Source

Journal of the American Geriatrics Society: Outcome Disparities in Geriatric Hip Fracture: Orthogeriatric Co‐Management Versus Internal Medicine Admission ↗

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