[Effectiveness of co-management between orthopaedic surgeons and internists for inpatient elders with hip fracture].
OBJECTIVE
Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM.


METHODS
Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used.


RESULTS
Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts.


CONCLUSIONS
Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months.
Servicio de Cirugía Ortopédica, Hospital Universitario de Elda, Elda, Alicante, España. Electronic address: lizaur1@telefonica.net.
Alejandro
A
Lizaur-Utrilla
Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España.
Juan V
JV
Calduch Broseta
Servicio de Cirugía Ortopédica, Hospital Universitario de Elda, Elda, Alicante, España.
Francisco A
FA
Miralles Muñoz
Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España.
Mar
M
Segarra Soria
Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España.
Manuel
M
Díaz Castellano
Unidad de Corta Estancia, Servicio de Medicina Interna, Hospital Universitario de Elda, Elda, Alicante, España.
Lucio
L
Andreu Giménez
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007388:Internal Medicine; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010348:Patient Care Team / Q000458:organization & administration*; D011183:Postoperative Complications; D015397:Program Evaluation; D011446:Prospective Studies; D016896:Treatment Outcome
Ancianos; Asistencia compartida; Comanaged care; Elder patients; Fractura de cadera; Hip fracture; Mortalidad; Mortality