Hip fracture surgery in Nova Scotia: a comparison of treatment provided by "generalist" general surgeons and orthopedic surgeons.
OBJECTIVE
To determine quality of hip fracture services provided by "generalist" general surgeons (generalists) in Nova Scotia.


METHODS
Chart review and postoperative, blinded, random-ordered radiologic analysis.


METHODS
Three community hospitals and 1 tertiary care hospital in Nova Scotia.


METHODS
Seven generalists who performed 120 hip fracture repairs and 7 orthopedic surgeons (specialists) who performed 135 hip fracture repairs.


METHODS
Patient demographics, preoperative, perioperative, postoperative and discharge information, technical quality of reduction as determined through postoperative radiologic assessment.


RESULTS
There were no differences between patients treated by generalists and those treated by specialists with respect to age, sex, American Society of Anesthesiologists' class, level of function and fracture type. Intraoperatively, the patient groups were similar with respect to type of anesthesia, use of antibiotics, number of transfusions and surgical complications. Significant differences were noted in length of operation (54.4 v. 41.1 minutes), use of C-arm imaging (6.7% v. 85.9%) and management of Garden classes 1 and 2 subcapital fractures. Postoperatively, the 2 groups had similar numbers of medical complications, wound complications, reoperations, readmissions and deaths, and a similar level of function on discharge. Significant differences included the number of intensive care unit admissions (5.8% v. 15.6%) and length of stay there (5.7 v. 2.8 days) and of postoperative stay (14.5 v. 10.7 days). The assessment of radiographs did not demonstrate any significant difference in the quality of reduction.


CONCLUSIONS
In Nova Scotia the outcomes of hip fracture surgery performed by generalists are comparable to those performed by specialists.
Chiasson
P M
PM
Department of Surgery, Dalhousie University, Halifax, NS.
Roy
P D
PD
Mitchell
M J
MJ
Chiasson
A M
AM
Alexander
D I
DI
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013502:General Surgery / Q000379:methods / Q000592:standards*; D006620:Hip Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D009985:Orthopedics / Q000379:methods / Q000592:standards*; D010351:Patient Discharge; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011859:Radiography; D012189:Retrospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome