title: Admitting service and morbidity and mortality in elderly patients after hip fracture: finding a threshold for medical versus orthopedic admission.
abstract: 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).
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, 94143-0728, USA. james.mok@ucsf.edu
authors.forename: James M
authors.initials: JM
authors.lastname: Mok
authors.forename: Salim K
authors.initials: SK
authors.lastname: Durrani
authors.forename: Akira
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Hubert T
authors.initials: HT
authors.lastname: Kim
mesh_terms: 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*