title: Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient's Hospital Length of Stay?
abstract: OBJECTIVE
  The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Urban level 1 trauma center.
  
  
  METHODS
  Six hundred fourteen geriatric hip fracture patients from 2000 to 2009.
  
  
  METHODS
  Orthopaedic surgery for geriatric hip fracture.
  
  
  METHODS
  Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service.
  
  
  RESULTS
  Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients.
  
  
  CONCLUSIONS
  This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient's expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient's expected LOS.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, Nashville, TN.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Greenberg
authors.forename: Jacob P
authors.initials: JP
authors.lastname: VanHouten
authors.forename: Nikita
authors.initials: N
authors.lastname: Lakomkin
authors.forename: Jesse
authors.initials: J
authors.lastname: Ehrenfeld
authors.forename: Amir Alex
authors.initials: AA
authors.lastname: Jahangir
authors.forename: Robert H
authors.initials: RH
authors.lastname: Boyce
authors.forename: William T
authors.initials: WT
authors.lastname: Obremksey
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000289:Admitting Department, Hospital / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006299:Health Services for the Aged; D006620:Hip Fractures / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D017678:Sex Distribution; D013714:Tennessee / Q000453:epidemiology