Severity of Illness Impacts Outcomes More than Admitting Service for Isolated Hip Fracture Patients

Abstract

Introduction Isolated hip fractures (IHF) are common injuries in the elderly. Controversy exists about which hospital service is best suited to manage these patients. We hypothesize that baseline patient severity of illness (SOI) score drives patient outcomes, not the hospital service managing these patients. Methods Retrospective review of all IHF patients from 2014 to 2018 at our Level 1 trauma center. Basic demographics were obtained. Patients were divided into service line they were admitted; surgical vs non-surgical. Primary outcomes included hospital length of stay (HLOS), time to OR, time to VTE prophylaxis, complication rate (defined by the Trauma Quality Improvement Program), 30-day mortality, and readmissions. SOI score (which is DRG-based) was controlled to see if any differences in primary outcomes occurred between cohorts. Chi-square was used for categorical variables and regression analysis for continuous variables. Significance was p \ 0.05. Results A total of 366 total patients were analyzed with the same ISS. A total of 102 were admitted to a surgical service and 264 to a non-surgical service. Average overall age was 80 year, 66.9% were female, and 86% were Caucasian. There was no statistical difference between outcomes when comparing admitting services. Controlling for SOI score, there was no difference between admitting service for outcomes as well. SOI score was a significant predictor for increased HLOS and complication occurrence (p \ 0.001) via regression analysis, with a 6.06-fold increase in complication rate from mild to moderate SOI score (p = 0.001). Conclusion There is no difference in outcomes based on admitting service and process measures. However, the SOI score is perhaps a better predictor of outcomes for isolated hip fracture patients.

Two surgical pathways for isolated hip fractures: A comparative study

“…A 2018 study by Lott et al [ 6 ] also concluded that patients with HF admitted to the medicine service had longer lengths of stay (LOS) and more complications compared to patients admitted to the trauma/orthopedic service. In contradiction to these conclusions, other studies determined that there were no differences in complication rates or LOS between the admitting services[ 8 , 10 ].…”

“…Patients can be hospitalized for operative fixation of HF through different pathways, including trauma, orthopedic, and medicine admitting services[ 5 - 8 ]. In the studies comparing surgical vs nonsurgical pathways it has been reported that the admitting service can affect the management patterns and outcomes of patients with HF[ 5 , 6 , 9 ].…”

“…The impact of preoperative pathways on the outcomes was previously addressed in diverse cohorts of patients, which differed in inclusion/exclusion criteria such as age, hospital settings, mechanism of injury, preoperative medication, or surgical management[ 7 , 8 , 10 - 12 ]. The rationale for our study was the existing controversy over which hospital service is best suited for the optimal admission process for patients with HF and associated with the best outcomes.…”

Elevated Red Blood Cell Distribution Width Is Associated with Poor Prognosis in Fractured Patients Admitted to Intensive Care Units

“…12,13 For individuals with isolated hip fractures, the severity of illness (SOI) score may be a better indicator of outcomes. 14 Other scores, the Nottingham Hip Fracture Score and the orthopaedic version of the Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity, and previously published risk prediction models could be time-consuming and inconvenient. [15][16][17] The red blood cell distribution width (RDW), which is the indication of size diversity among circulating red blood cells, has been as a biomarker reflecting systemic inflammation and malnutrition among elderly people.…”

“… 12 , 13 For individuals with isolated hip fractures, the severity of illness (SOI) score may be a better indicator of outcomes. 14 Other scores, the Nottingham Hip Fracture Score and the orthopaedic version of the Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity, and previously published risk prediction models could be time‐consuming and inconvenient. 15 , 16 , 17 …”