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Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists

Rotating medical consultants, hospitalists or geriatricians, are involved in the care of patients with hip fracture, often after medical complications have already occurred. In August 2012, we implemented a unique surgical comanagement (SCM) model in which the same Internal Medicine hospitalists are...

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Autores principales: Rohatgi, Nidhi, Weng, Yingjie, Kittle, Jessie, Ahuja, Neera
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954368/
https://www.ncbi.nlm.nih.gov/pubmed/33720101
http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00231
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author Rohatgi, Nidhi
Weng, Yingjie
Kittle, Jessie
Ahuja, Neera
author_facet Rohatgi, Nidhi
Weng, Yingjie
Kittle, Jessie
Ahuja, Neera
author_sort Rohatgi, Nidhi
collection PubMed
description Rotating medical consultants, hospitalists or geriatricians, are involved in the care of patients with hip fracture, often after medical complications have already occurred. In August 2012, we implemented a unique surgical comanagement (SCM) model in which the same Internal Medicine hospitalists are dedicated year-round to the orthopaedic surgery service. We examine whether this SCM model was associated with a decrease in medical complications, length of stay, and inpatient mortality in patients with hip fracture admitted at our institution, compared with the previous model. METHODS: We included 2,252 admissions to the orthopaedic surgery service with a hip fracture between 2009 and 2018 (757 pre-SCM and 1495 post-SCM). We adjusted for age, Charlson comorbidity score, and operating time in all regression analyses. RESULTS: Mean Charlson comorbidity score (1.6 versus 1.2) and median case mix index (2.1 versus 1.9) were higher in the post-SCM group. A 32% decrease was observed in the odds of having ≥1 medical complication(s) (odds ratio, 0.68 [95% confidence interval, 0.50 to 0.91], P = 0.009) post-SCM. No change was observed in length of stay or inpatient mortality despite an increase in medical complexity post-SCM. CONCLUSION: Having dedicated orthopaedic hospitalists may contribute to fewer medical complications in patients with hip fracture.
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spelling pubmed-79543682021-03-15 Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists Rohatgi, Nidhi Weng, Yingjie Kittle, Jessie Ahuja, Neera J Am Acad Orthop Surg Glob Res Rev Research Article Rotating medical consultants, hospitalists or geriatricians, are involved in the care of patients with hip fracture, often after medical complications have already occurred. In August 2012, we implemented a unique surgical comanagement (SCM) model in which the same Internal Medicine hospitalists are dedicated year-round to the orthopaedic surgery service. We examine whether this SCM model was associated with a decrease in medical complications, length of stay, and inpatient mortality in patients with hip fracture admitted at our institution, compared with the previous model. METHODS: We included 2,252 admissions to the orthopaedic surgery service with a hip fracture between 2009 and 2018 (757 pre-SCM and 1495 post-SCM). We adjusted for age, Charlson comorbidity score, and operating time in all regression analyses. RESULTS: Mean Charlson comorbidity score (1.6 versus 1.2) and median case mix index (2.1 versus 1.9) were higher in the post-SCM group. A 32% decrease was observed in the odds of having ≥1 medical complication(s) (odds ratio, 0.68 [95% confidence interval, 0.50 to 0.91], P = 0.009) post-SCM. No change was observed in length of stay or inpatient mortality despite an increase in medical complexity post-SCM. CONCLUSION: Having dedicated orthopaedic hospitalists may contribute to fewer medical complications in patients with hip fracture. Wolters Kluwer 2021-03-10 /pmc/articles/PMC7954368/ /pubmed/33720101 http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00231 Text en Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY) (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Rohatgi, Nidhi
Weng, Yingjie
Kittle, Jessie
Ahuja, Neera
Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists
title Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists
title_full Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists
title_fullStr Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists
title_full_unstemmed Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists
title_short Merits of Surgical Comanagement of Patients With Hip Fracture by Dedicated Orthopaedic Hospitalists
title_sort merits of surgical comanagement of patients with hip fracture by dedicated orthopaedic hospitalists
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954368/
https://www.ncbi.nlm.nih.gov/pubmed/33720101
http://dx.doi.org/10.5435/JAAOSGlobal-D-20-00231
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