Admitting service and morbidity and mortality in elderly patients after hip fracture: finding a threshold for medical versus orthopedic admission.
Outcomes by admitting service of 355 consecutive patients admitted for hip fracture at an academic medical center were retrospectively studied. An adverse event occurred in 53 patients (14.9%): 10 in-hospital deaths, 37 intensive care unit transfers, and 25 deaths within 30 days. No significant difference was found between percentages of patients with adverse events admitted to a medical service versus an orthopedic service (52.8% vs 47.2%; P = .8). Criteria that determine admitting service based on medical acuity do not adequately allocate patients at risk for serious morbidity and early mortality to a medical service. Addition of American Society of Anesthesiologists grade 4 and men 85 or older to existing criteria would increase the percentage of patients with adverse events admitted to a medical service (72% vs 28%; P<.005).
Mok
James M
JM
Department of Orthopaedic Surgery, University of California, San Francisco, 94143-0728, USA. james.mok@ucsf.edu
Durrani
Salim K
SK
Yamamoto
Akira
A
Kim
Hubert T
HT
D000289:Admitting Department, Hospital / Q000379:methods* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000401:mortality*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009985:Orthopedics; D010343:Patient Admission; D010360:Patient Transfer; D012189:Retrospective Studies; D015996:Survival Rate; D014218:Triage / Q000379:methods*