Skip to main content
SpringerLink
Log in

Severity of Illness Impacts Outcomes More than Admitting Service for Isolated Hip Fracture Patients

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Introduction

Isolated hip fractures (IHF) are common injuries in the elderly. Controversy exists about which hospital service is best suited to manage these patients. We hypothesize that baseline patient severity of illness (SOI) score drives patient outcomes, not the hospital service managing these patients.

Methods

Retrospective review of all IHF patients from 2014 to 2018 at our Level 1 trauma center. Basic demographics were obtained. Patients were divided into service line they were admitted; surgical vs non-surgical. Primary outcomes included hospital length of stay (HLOS), time to OR, time to VTE prophylaxis, complication rate (defined by the Trauma Quality Improvement Program), 30-day mortality, and readmissions. SOI score (which is DRG-based) was controlled to see if any differences in primary outcomes occurred between cohorts. Chi-square was used for categorical variables and regression analysis for continuous variables. Significance was p < 0.05.

Results

A total of 366 total patients were analyzed with the same ISS. A total of 102 were admitted to a surgical service and 264 to a non-surgical service. Average overall age was 80 year, 66.9% were female, and 86% were Caucasian. There was no statistical difference between outcomes when comparing admitting services. Controlling for SOI score, there was no difference between admitting service for outcomes as well. SOI score was a significant predictor for increased HLOS and complication occurrence (p < 0.001) via regression analysis, with a 6.06-fold increase in complication rate from mild to moderate SOI score (p = 0.001).

Conclusion

There is no difference in outcomes based on admitting service and process measures. However, the SOI score is perhaps a better predictor of outcomes for isolated hip fracture patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zuckerman JD (1996) Hip fracture. N Engl J Med 334:1519–1525

    Article  CAS  Google Scholar 

  2. Schnell S, Friedman SM, Mendelson DA et al (2010) The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil 1(1):6–14

    Article  Google Scholar 

  3. Liang L, Moore B, Soni A (2020) National inpatient hospital costs: the most expensive conditions by payer, 2017. Healthcare Cost and Utilization Projec from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb261-Most-Expensive-Hospital-Conditions-2017.jsp

  4. Dolan P, Torgerson DJ (1998) The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int 8:611–617

    Article  CAS  Google Scholar 

  5. Miyamoto RG, Kaplan KM, Levine BR et al (2008) Surgical management of hip fractures: An evidence-based review of the literature. I: femoral neck fractures. J Am Acad of Orthop Surg 16(10):596–607

    Article  Google Scholar 

  6. Patel JN, Klein DS, Sreekumar SS et al (2020) Outcomes in multidisciplinary team-based approach in geriatric hip fracture care: a systemic review. J Am Acad Orthop Surg 28:128–133

    Article  Google Scholar 

  7. Siu CW, Sun NCH, Lau TW et al (2010) Preoperative cardiac risk assessment in geriatric patients with hip fractures: an orthopedic surgeons’ perspective. Osteoporos Int 21(Suppl 4):S587–S591

    Article  CAS  Google Scholar 

  8. Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S-17S

    Article  CAS  Google Scholar 

  9. Barone A, Giusti A, Pizzonia M et al (2006) A comprehensive geriatric intervention reduces short- and long-term mortality in older people with hip fracture. J Am Geriatr Soc 54(7):1145–1147

    Article  Google Scholar 

  10. Roberts KC, Brox WT, Jevsevar DS et al (2015) Management of hip fractures in the elderly. J Am Acad Orthop Surg 23:131–137

    Article  Google Scholar 

  11. https://www.facs.org/quality-programs/trauma/quality/trauma-quality-improvement-program/ (accessed June 10th, 2022)

  12. Horn SD, Horn RA, Sharkey PD (1984) The severity of illness index as a severity adjustment to diagnosis-related groups. Health Care Financ Rev Suppl pp 33–45

  13. Gabbe BJ, Magtengaard K, Hannaford AP et al (2005) Is the Charlson Comorbidity Index useful for predicting trauma outcomes? Acad Emerg Med 12(4):318–321

    Article  Google Scholar 

  14. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  Google Scholar 

  15. Magaziner J, Hawkes W, Herbel JR et al (2000) Recovery from hip fractures in eight areas of function. J Gerontol A Biol Sci Med Sci 55:M498–M507

    Article  CAS  Google Scholar 

  16. American College of Surgeons Verification Review Consultation (accessed February 26th, 2022) VRC Standards Frequently Asked Questions from https://www.facs.org/quality-programs/trauma/tqp/center-programs/vrc/faq/standards

  17. Moran CG, Wenn RT, Sikand M et al (2005) Early mortality after hip fracture: Is delay before surgery important? J Bone Joint Surg Am 87:483–489

    PubMed  Google Scholar 

  18. Lofgren S, Rehnberg C, Ljunggren, et al (2015) Coordination pays off: A comparison of two models for organizing hip fracture care, outcomes and costs. Int J Health Plann Manage 30:426–438

    Article  Google Scholar 

  19. Soong C, Cram P, Chezar K et al (2016) Impact of integrated hip fracture inpatient program on length of stay and costs. J Orthop Trauma 30:647–652

    Article  Google Scholar 

  20. Della Rocca GJ, Moylan KC, Crist BD et al (2013) Comanagement of geriatric patients with hip fractures: a retrospective, controlled, cohort study. Geriatr Orthop Surg Rehabil 4:10–15

    Article  Google Scholar 

  21. Swart E, Vasudeva E, Makhni EC et al (2016) Dedicated perioperative hip fracture comanagement programs are cost-effective in high-volume centers: An economic analysis. Clin Orthop Relat Res 474:222–233

    Article  Google Scholar 

  22. Nyholm AM, Gromov K, Palm H et al (2015) Time to surgery is associated with thirty-day and ninety-day mortality after proximal femoral fracture: A retrospective observational study on prospectively collected data from the Danish fracture database collaborators. J Bone Joint Surg Am 97:1333–1339

    Article  Google Scholar 

  23. Daugaard CL, Jorgensen HL, Riis T et al (2012) Is mortality after hip fracture associated with surgical delay or admission during weekends and public holidays? A retrospective study of 38,020 patients. Acta Orthop 83:609–613

    Article  Google Scholar 

  24. Tan LT, Wong SJ, Kwek EB (2017) Inpatient cost for hip fracture patients managed with an orthogeriatric care model in Singapore. Sinapore Med J 58:139–144

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Trauma, Emergency General Surgery and Critical Care Surgery, Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE, 68198-3280, USA

    Zachary M. Bauman, Paige Phillips, Emily Cantrell, Ashley Raposo-Hadley, Megha Patel, Charity H. Evans & Andrew Kamien

Authors
  1. Zachary M. Bauman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paige Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily Cantrell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ashley Raposo-Hadley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Megha Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Charity H. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew Kamien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zachary M. Bauman.

Ethics declarations

Conflict of interest

Dr. Zachary Bauman is a paid educational consultant for KLS-Martin, Zimmer-Biomet, and Atricure. No other authors have any conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bauman, Z.M., Phillips, P., Cantrell, E. et al. Severity of Illness Impacts Outcomes More than Admitting Service for Isolated Hip Fracture Patients. World J Surg 46, 2344–2349 (2022). https://doi.org/10.1007/s00268-022-06659-x

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-022-06659-x

Search

Navigation