Medicine versus Orthopaedic Service for Hospital Management of Hip Fractures

Background Hospital care of patients with hip fractures often is managed primarily by either a medicine or orthopaedic service, depending on the institution. Whether complication rates, length of stay, or time to surgery differs on different services is unknown. Questions/purposes We therefore determined whether (1) perioperative complication rates, and (2) length of stay and time to surgery for patients undergoing surgical management of hip fractures differed by the specialty of the primary service. Patients and Methods We performed a retrospective cohort study at a university-based academic hospital of patients undergoing surgery for hip fracture admitted to medicine and orthopaedic services during 2006. Of the 98 patients included in the analysis, 34% were managed by a medicine service and 66% by orthopaedics. Using multivariable regression models to adjust for patient characteristics and comorbidities, we determined whether service designation predicted the likelihood of severe or intermediate perioperative complications, length of stay, or time to surgery. Results The rate of severe or intermediate complications for patients undergoing surgical management of hip fractures was 30%. Patients with medicine or orthopaedic services did not differ in the rate of severe or intermediate complications or length of stay in adjusted analysis. However, time to surgery was longer in patients managed by the medical service in adjusted analysis. Conclusions In our patient cohort, the likelihood of perioperative complications occurring among patients with hip fractures did not differ by service designation in adjusted analysis. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.