Medicine versus orthopaedic service for hospital management of hip fractures.
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.


OBJECTIVE
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.


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.


METHODS
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Chuang
Cynthia H
CH
Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA, USA. cchuang@psu.edu
Pinkowsky
Gregory J
GJ
Hollenbeak
Christopher S
CS
Armstrong
April D
AD
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006302:Health Services Research; D006620:Hip Fractures / Q000601:surgery*; D020445:Hospitalists; D006785:Hospitals, University; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D007902:Length of Stay; D008297:Male; D009985:Orthopedics; D010414:Pennsylvania / Q000453:epidemiology; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013997:Time Factors; D014850:Waiting Lists