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Medicine versus Orthopaedic Service for Hospital Management of Hip Fractures

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Hospital care of patients with hip fractures often is managed primarily by either a medicine or orthopaedic service, depending on the institution. Whether complication rates, length of stay, or time to surgery differs on different services is unknown.

Questions/purposes

We therefore determined whether (1) perioperative complication rates, and (2) length of stay and time to surgery for patients undergoing surgical management of hip fractures differed by the specialty of the primary service.

Patients and Methods

We performed a retrospective cohort study at a university-based academic hospital of patients undergoing surgery for hip fracture admitted to medicine and orthopaedic services during 2006. Of the 98 patients included in the analysis, 34% were managed by a medicine service and 66% by orthopaedics. Using multivariable regression models to adjust for patient characteristics and comorbidities, we determined whether service designation predicted the likelihood of severe or intermediate perioperative complications, length of stay, or time to surgery.

Results

The rate of severe or intermediate complications for patients undergoing surgical management of hip fractures was 30%. Patients with medicine or orthopaedic services did not differ in the rate of severe or intermediate complications or length of stay in adjusted analysis. However, time to surgery was longer in patients managed by the medical service in adjusted analysis.

Conclusions

In our patient cohort, the likelihood of perioperative complications occurring among patients with hip fractures did not differ by service designation in adjusted analysis.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA

    Cynthia H. Chuang MD, MSc

  2. Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA

    Cynthia H. Chuang MD, MSc & Christopher S. Hollenbeak PhD

  3. Department of Orthopaedics, Penn State College of Medicine, Hershey, PA, USA

    Gregory J. Pinkowsky MD & April D. Armstrong MD, MSc, FRCSC

  4. Department of Surgery, Penn State College of Medicine, Hershey, PA, USA

    Christopher S. Hollenbeak PhD

  5. Penn State Milton S. Hershey Medical Center, 600 Centerview Drive, A210, Hershey, PA, 17033, USA

    Cynthia H. Chuang MD, MSc

Authors
  1. Cynthia H. Chuang MD, MSc
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  2. Gregory J. Pinkowsky MD
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  3. Christopher S. Hollenbeak PhD
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  4. April D. Armstrong MD, MSc, FRCSC
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Corresponding author

Correspondence to Cynthia H. Chuang MD, MSc.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Penn State College of Medicine/Milton S. Hershey Medical Center, Hershey, PA, USA.

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Chuang, C.H., Pinkowsky, G.J., Hollenbeak, C.S. et al. Medicine versus Orthopaedic Service for Hospital Management of Hip Fractures. Clin Orthop Relat Res 468, 2218–2223 (2010). https://doi.org/10.1007/s11999-010-1290-z

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  • DOI: https://doi.org/10.1007/s11999-010-1290-z

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