Key result
Medicine admission for hip fractures is linked to ~103% more Vitamin D diagnoses without reducing complications.
Why the study?
Protocols for caring for elderly hip fracture patients vary among hospitals, necessitating examination of different care approaches at a single institution.
Does a new plan of care admitting all elderly hip fracture patients to medicine improve perioperative complications, time to surgery, and length of stay compared to nonstandard admission?
Observational (n=389)
No
Does a new plan of care admitting all elderly hip fracture patients to medicine improve perioperative complications, time to surgery, and length of stay compared to nonstandard admission?
Admitting all elderly hip fracture patients to a medicine service did not improve perioperative complications or length of stay but increased the diagnosis of Vitamin D deficiency and transfusion rates.
Observational data do not support routine medicine admission to reduce complications; leaves open whether standardized pathways improve hip fracture outcomes.
Introduction: Protocols for caring for elderly hip fracture patients vary among hospitals. The purpose of this study was to examine two different approaches of care for this patient population at our institution. Methods: Retrospective review of 389 consecutive patients 65 years and older with the diagnosis of a low- energy, hip fracture between January 2006 and May 2010. 227 consecutive patients for which a nonstandard method of admission (OP) to either medicine (133 patients) or orthopedic service (94 patients) were compared to a new plan of care (NP) that included 162 consecutive patients in which all patients were admitted to medicine. We evaluated perioperative complications rates, time to surgery (TTS), and length of hospital stay (LOS). Results: There were no significant differences in LOS, TTS, 30 day re-admission, rapid response codes, perioperative complications or death between either model of care. The NP did demonstrate a significant increase in patients being transfused (51.85% vs. 36.56%) and number of patients being diagnosed with Vitamin D deficiency (42.12% vs. 20.70%). Conclusion: While our change in protocol did not alter the rate of perioperative complications, nor did it provide quicker care or shorter hospital stays, it did provide more comprehensive osteoporosis care to our patients
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Christopher Brown (2012) conducted an observational in low-energy hip fracture (n=389). New plan of care (admission to medicine) vs. Nonstandard method of admission (medicine or orthopedic service) was evaluated on Perioperative complications rates, time to surgery (TTS), and length of hospital stay (LOS). A new plan of care admitting all elderly hip fracture patients to medicine did not alter perioperative complications but increased diagnoses of Vitamin D deficiency (42.12% vs. 20.70%).
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