[Effectiveness of co-management between orthopaedic surgeons and internists for inpatient elders with hip fracture]

Hip fracture is a common injury in elder patients who have comorbidities, and it increases the risk of morbimortality. They could benefit from co-management (CM) between orthopaedic surgeons and internists. The objective was to evaluate the effectiveness of this CM.

Prospective study of 138 patients over 64 years with hip fracture treated with CM care and one-year of follow-up. The control group was a cohort of 153 patients with similar criteria who had been treated with conventional care. Several pre- and postsurgical variables, complications, and potential risk factors for mortality were analyzed. The Charlson index, mental test, Katz and SF-12 quality of life questionnaires, and Merle D'Aubigné hip score were used.

Surgical delay was lower in the CM cohort (P=.001). The rates of complications and readmissions were similar in both cohorts. The average stay was lower (P=.001) in the CM cohort. In-hospital and 3-month mortality were similar, but it was lower in the CM cohort at 6 (P=.04) and 12 months (P=.03). In both cohorts, gender, number of comorbidities, ASA score, Charlson index or surgery type were not predictors of mortality. Surgical delay>2 days was a predictor in the CM cohort, whereas age was a predictor in the control cohort. The final functional outcomes were similar in both cohorts.

Our results show the effectiveness of this CM to reduce surgical delay, hospital stay and mortality at 6 months.