Hip fracture complications do not differ by care service specialty
MedWire News: The likelihood of perioperative complications occurring among patients with hip fractures does not differ by the specialty of the primary service they receive, US researchers report.
"Hospital care of patients with hip fractures often is managed primarily by either a medicine or orthopedic service, depending on the institution," explain Cynthia Chuang (Penn State College of Medicine, Hershey, Pennsylvania) and colleagues.
"However, it is not known whether primary assignment to an orthopedic team versus a medical team affects the likelihood of perioperative complications or lengths of stay for patients undergoing surgery for hip fractures," they add.
To investigate, Chuang and team retrospectively reviewed data for 98 patients undergoing surgery for hip fracture, who were admitted to medicine and orthopedic services at a university-based academic hospital during 2006.
In all, 34% of patients were managed by a medicine service and 66% by orthopedics.
The researchers report that the overall rate of severe or intermediate complications after hip fracture surgery was 30%.
After adjustment for patient characteristics and comorbidities, the rate of severe or intermediate complications did not differ between patients treated at the medicine and orthopedic services. The presence of coronary artery disease was the only predictor of severe or intermediate complications.
The median length of stay was also similar for the two services, at 4 days for orthopedics and 6 days for medicine. In contrast, time to surgery was significantly longer in patients managed by the medical service, at 18.5 hours compared with patients managed by the orthopedic service, at 12.0 hours.
Patients managed by the medical team may have required more preoperative evaluation or stabilization before surgery, which could explain the difference observed, say the researchers.
"Delays also may have resulted from extra time needed to coordinate the medicine service with the orthopedic surgical team," they add.
"Although multidisciplinary approaches to hospital management of surgical patients with hip fractures have resulted in reduced complication rates as reported in other studies, our study suggests simply shifting the primary management from the surgical team to the medical team (or vice versa) does not," Chuang and co-authors conclude in the journal Clinical Orthopaedics and Related Research.
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By Laura Dean