Does a Multidisciplinary Team Decrease Complications in Male Patients With Hip Fractures?

Abstract

Background Men with hip fractures are more likely to experience postoperative complications than women. The Medical Orthopaedic Trauma Service program at New York Presbyterian Hospital utilizes a multidisciplinary team approach to care for patients with hip fractures. The service is comanaged by an attending hospitalist and orthopaedic surgeon, with daily walking rounds attended by the hospitalist, orthopaedic resident, physical therapist, social worker, and a dedicated Medical Orthopaedic Trauma Service physician assistant. Questions/purposes We asked whether a multidisciplinary service for patients with hip fracture decreases (1) the incidence of inpatient complications in men, (2) the length of hospitalization, and (3) 90-day and 1-year mortality. Patients and Methods We retrospectively reviewed the charts of 74 men who had surgery for a nonperiprosthetic femoral neck, intertrochanteric, or subtrochanteric fracture for two 7-month periods before and after implementation of the Medical Orthopaedic Trauma Service. Age, ethnicity, comorbidity status, time to surgery, and postoperative complication data were collected. Regression modeling was used to evaluate the likelihood of postoperative complications, length of hospitalization, and 90-day and 1-year mortality while controlling for age, Charlson Comorbidity Index score, fracture type, and time from admission to surgery. Results We observed a decrease in the likelihood of experiencing at least one inpatient complication in male patients after implementation of the Medical Orthopaedic Trauma Service (odds ratio = 0.264). There was no difference in length of hospitalization, 90-day mortality, or 1-year mortality. Conclusions Multidisciplinary collaboration for patients with hip fractures can decrease the likelihood of experiencing inpatient complications in male patients.Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

One-Year Mortality After Acetabular Fractures in Elderly Patients Presenting to a Level-1 Trauma Center

“…The results of this study indicate that isolated acetabular fractures, with an overall 1-year mortality rate of 8.1% in elderly patients, do not hold the same 1-year mortality rates as hip fractures. When directly comparing these results with those from the above elderly hip fractures studies, 9,15,16 a significantly lower rate in overall 1-year mortality was found (P = 0.003-0.03).…”

“…9,15,16 Hip fracture patients treated nonoperatively, most commonly because of significant medical comorbidities, have reported 1-year mortality rates as high as 50%. 15 These data have occasionally been translated over to acetabular fractures by some physicians to help guide treatment decisions in elderly patients.…”

“…However, this was not seen, as the average CCI of 2.2 6 1.2 (0-6) was similar to a recently published population of operative hip fractures with a 1-year mortality of 22.5% (CCI, 1.7 6 1.7; range, 0-8). 9 Prior studies assessing 1-year mortality of geriatric acetabular fractures included patients with significant injuries to other body systems, similar to the nonisolated patient group in this study. 4,5 A 23.3% 1-year mortality rate was seen in the nonisolated group of this study, which is similar to 25% mortality rate (P = 0.0005) of O'Toole et al; however, more than 13.9% mortality rate (P = 0.07) of Gary et al Overall, a significantly higher rate of mortality was seen across all time points compared with the isolated fracture patients.…”

An Orthopedic-Hospitalist Comanaged Hip Fracture Service Reduces Inpatient Length of Stay

“…9 However, literature on the efficacy of these comanagement strategies for hip fracture patients has reported mixed results. 3,10-16 …”

Surgical Multidisciplinary Rounds

“…4,[8][9][10][11] Measurable outcomes such as shorter length of stay, improved morbidity and mortality, and decreased pulmonary complications (ventilator-associated infections, acute respiratory distress syndrome) have been reported in trauma, orthopedic, cardiac surgery, and critical care programs that utilize a format including care providers across multiple specialties and all points of patient care. 5,[12][13][14] Berkshire Medical Center applied this multidisciplinary approach to the care of all medical inpatients. Initially, the primary focus was to improve process measures such as the American Heart Association's Get With the Guidelines program and CMS core measures related to acute myocardial infarction and community-acquired pneumonia.…”