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Two surgical pathways for isolated hip fractures: A comparative study

BACKGROUND: Hip fractures (HF) are common among the aging population, and surgery within 48 h is recommended. Patients can be hospitalized for surgery through different pathways, either trauma or medicine admitting services. AIM: To compare management and outcomes among patients admitted through the...

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Autores principales: Fokin, Alexander A, Wycech Knight, Joanna, Darya, Maral, Stalder, Ryan, Puente, Ivan, Weisz, Russell D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292054/
https://www.ncbi.nlm.nih.gov/pubmed/37377993
http://dx.doi.org/10.5312/wjo.v14.i6.399
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author Fokin, Alexander A
Wycech Knight, Joanna
Darya, Maral
Stalder, Ryan
Puente, Ivan
Weisz, Russell D
author_facet Fokin, Alexander A
Wycech Knight, Joanna
Darya, Maral
Stalder, Ryan
Puente, Ivan
Weisz, Russell D
author_sort Fokin, Alexander A
collection PubMed
description BACKGROUND: Hip fractures (HF) are common among the aging population, and surgery within 48 h is recommended. Patients can be hospitalized for surgery through different pathways, either trauma or medicine admitting services. AIM: To compare management and outcomes among patients admitted through the trauma pathway (TP) vs medical pathway (MP). METHODS: This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures (AO/Orthopedic Trauma Association Type 31) who underwent surgery at a level 1 trauma center between 2016-2021. There were 69 patients admitted through the TP and 2025 admitted through the MP. To ensure comparability between groups, 66 of the 2025 MP patients were propensity matched to 66 TP patients by age, sex, HF type, HF surgery, and American Society of Anesthesiology score. The statistical analyses included multivariable analysis, group characteristics, and bivariate correlation comparisons with the χ² test and t-test. RESULTS: After propensity matching, the mean age in both groups was 75-years-old, 62% of both groups were females, the main HF type was intertrochanteric (TP 52% vs MP 62%), open reduction internal fixation was the most common surgery (TP 68% vs MP 71%), and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP. The majority of patients in TP and MP (71% vs 74%) were geriatric (≥ 65-years-old). Falls were the main mechanism of injury in both groups (77% vs 97%, P = 0.001). There were no significant differences in pre-surgery anticoagulation use (49% vs 41%), admission day of the week, or insurance status. The incidence of comorbidities was equal (94% for both) with cardiac comorbidities being dominant in both groups (71% vs 73%). The number of preoperative consultations was similar for TP and MP, with the most common consultation being cardiology in both (44% and 36%). HF displacement occurred more among TP patients (76% vs 39%, P = 0.000). Time to surgery was not statistically different (23 h in both), but length of surgery was significantly longer for TP (59 min vs 41 min, P = 0.000). Intensive care unit and hospital length of stay were not statistically different (5 d vs 8 d and 6 d for both). There were no statistical differences in discharge disposition and mortality (3% vs 0%). CONCLUSION: There were no differences in outcomes of surgeries between admission through TP vs MP. The focus should be on the patient’s health condition and on prompt surgical intervention.
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spelling pubmed-102920542023-06-27 Two surgical pathways for isolated hip fractures: A comparative study Fokin, Alexander A Wycech Knight, Joanna Darya, Maral Stalder, Ryan Puente, Ivan Weisz, Russell D World J Orthop Retrospective Cohort Study BACKGROUND: Hip fractures (HF) are common among the aging population, and surgery within 48 h is recommended. Patients can be hospitalized for surgery through different pathways, either trauma or medicine admitting services. AIM: To compare management and outcomes among patients admitted through the trauma pathway (TP) vs medical pathway (MP). METHODS: This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures (AO/Orthopedic Trauma Association Type 31) who underwent surgery at a level 1 trauma center between 2016-2021. There were 69 patients admitted through the TP and 2025 admitted through the MP. To ensure comparability between groups, 66 of the 2025 MP patients were propensity matched to 66 TP patients by age, sex, HF type, HF surgery, and American Society of Anesthesiology score. The statistical analyses included multivariable analysis, group characteristics, and bivariate correlation comparisons with the χ² test and t-test. RESULTS: After propensity matching, the mean age in both groups was 75-years-old, 62% of both groups were females, the main HF type was intertrochanteric (TP 52% vs MP 62%), open reduction internal fixation was the most common surgery (TP 68% vs MP 71%), and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP. The majority of patients in TP and MP (71% vs 74%) were geriatric (≥ 65-years-old). Falls were the main mechanism of injury in both groups (77% vs 97%, P = 0.001). There were no significant differences in pre-surgery anticoagulation use (49% vs 41%), admission day of the week, or insurance status. The incidence of comorbidities was equal (94% for both) with cardiac comorbidities being dominant in both groups (71% vs 73%). The number of preoperative consultations was similar for TP and MP, with the most common consultation being cardiology in both (44% and 36%). HF displacement occurred more among TP patients (76% vs 39%, P = 0.000). Time to surgery was not statistically different (23 h in both), but length of surgery was significantly longer for TP (59 min vs 41 min, P = 0.000). Intensive care unit and hospital length of stay were not statistically different (5 d vs 8 d and 6 d for both). There were no statistical differences in discharge disposition and mortality (3% vs 0%). CONCLUSION: There were no differences in outcomes of surgeries between admission through TP vs MP. The focus should be on the patient’s health condition and on prompt surgical intervention. Baishideng Publishing Group Inc 2023-06-18 /pmc/articles/PMC10292054/ /pubmed/37377993 http://dx.doi.org/10.5312/wjo.v14.i6.399 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Retrospective Cohort Study
Fokin, Alexander A
Wycech Knight, Joanna
Darya, Maral
Stalder, Ryan
Puente, Ivan
Weisz, Russell D
Two surgical pathways for isolated hip fractures: A comparative study
title Two surgical pathways for isolated hip fractures: A comparative study
title_full Two surgical pathways for isolated hip fractures: A comparative study
title_fullStr Two surgical pathways for isolated hip fractures: A comparative study
title_full_unstemmed Two surgical pathways for isolated hip fractures: A comparative study
title_short Two surgical pathways for isolated hip fractures: A comparative study
title_sort two surgical pathways for isolated hip fractures: a comparative study
topic Retrospective Cohort Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10292054/
https://www.ncbi.nlm.nih.gov/pubmed/37377993
http://dx.doi.org/10.5312/wjo.v14.i6.399
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