title: Implementation of a co-managed Geriatric Fracture Center reduces hospital stay and time-to-operation in elderly femoral neck fracture patients.
abstract: OBJECTIVE
  To evaluate changes in hospital length-of-stay and time-to-operation of older hip fracture patients before and after the foundation of a co-managed Geriatric Fracture Center (GFC).
  
  
  METHODS
  A co-managed GFC was established in a German level-1 trauma center. In a retrospective cohort study, we analyzed femoral neck fracture patients >60 years treated with hemiarthroplasty. Patients treated within the first year after foundation of the GFC were compared to the patients treated during the year before. One-way ANOVA was performed to identify differences regarding time-to-operation and hospital length-of-stay.
  
  
  RESULTS
  One hundred and fourteen patients of the GFC were compared to 169 patients previously treated without co-management. Mean patient age did not significantly differ (81.9 vs. 81.5 years; p = 0.7), nor did gender distribution. Hospital length-of-stay was significantly shorter after foundation of the GFC (13.9 vs. 16.8 days; p = 0.007). The same is true for the interval between hospital admission and operation, which decreased from 3.1 to 2.1 days (p = 0.029). Early surgical complication rate was not significantly affected by GFC foundation (7.7 % pre-GFC vs. 9.6 % GFC; p = 0.6), nor was inpatient mortality (5.9 % pre-GFC vs. 4.4 % GFC; p = 0.6). Subgroup analysis revealed that GFC patients without early surgical complications displayed a reduced length-of-stay (LOS), whereas LOS was even prolonged in GFC patients with surgical complications.
  
  
  CONCLUSIONS
  A co-managed GFC offering an organized fracture program for the elderly can reduce hospital length-of-stay and time-to-operation in hip fracture patients. A significant effect can be observed within the first year after establishment of a GFC.
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Klinikum Nuernberg, Breslauer Str. 201, 90471, Nuremberg, Germany, biber@klinikum-nuernberg.de.
authors.forename: Roland
authors.initials: R
authors.lastname: Biber
authors.forename: Katrin
authors.initials: K
authors.lastname: Singler
authors.forename: Marco
authors.initials: M
authors.lastname: Curschmann-Horter
authors.forename: Susanne
authors.initials: S
authors.lastname: Wicklein
authors.forename: Cornel
authors.initials: C
authors.lastname: Sieber
authors.forename: Hermann Josef
authors.initials: HJ
authors.lastname: Bail
mesh_terms: D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005853:Geriatrics; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000458:organization & administration*