Orthopedics

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Impact of a comanaged geriatric fracture center on short-term hip fracture outcomes
Archives of Internal Medicine, 10/14/09

Friedman SM et al. – Hip fractures are associated with substantial morbidity and mortality for older adults. Patients sustaining hip fractures usually have comorbid conditions that may benefit from comanagement by geriatricians and orthopedic surgeons.Comanagement by geriatricians and orthopedic surgeons, combined with standardized care, leads to improved processes and outcomes for patients with hip fractures.

• Patients comanaged daily by geriatrician and orthopedic surgeon, emphasizing total quality management, timely treatment, and standardized care
• medical records reviewed to compare process and outcome measures in GFC with local institution that did not have fracture management service
• Patients 60 years or older admitted for proximal femur fracture from May 1, 2005, to April 30, 2006, included
• Pathological, recurrent, high-energy, periprosthetic, and nonoperative fractures excluded

• Geriatric Fracture Center patients (n = 193) significantly older, less likely to reside in community, and had more comorbid conditions and dementia than usual care patients (n = 121)
• Despite baseline differences, GFC patients, compared with usual care patients, had shorter times to surgery (24.1 vs 37.4 hours), fewer postoperative infections (2.3% vs 19.8%), fewer complications overall (30.6% vs 46.3%), and shorter length of stay (4.6 vs 8.3 days)
• Compared with GFC patients, physical restraint use significantly higher in usual care patients (0% vs 14.1%)
• After adjustment for baseline characteristics, patients treated in the GFC had shorter times to surgery, shorter length of stay, fewer cardiac complications, and fewer cases of thromboembolism, delirium, and infection
• No difference in in-hospital mortality or 30-day readmission rate

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