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Implementation of a Geriatrics-Focused Orthopaedic and Hospitalist Fracture Program Decreases Perioperative
Christine Bub1, Erik Stapleton2, Cesar Iturriaga1
1Zucker School of Medicine at Hofstra/Northwell, Department of Orthopaedic Surgery, Long Island Jewish Hospital, Northwell Health, Great Neck, NY.
Objective:
To evaluate whether the implementation of a geriatrics-focused orthopaedic and hospitalist comanagement program can improve perioperative outcomes and decrease resource utilization.
Design:
A retrospective chart review study was conducted before and after the implementation of a geriatrics-focused orthopaedic and hospitalist comanagement program, based on the American Geriatrics Society (AGS) AGS CoCare:Ortho.
Setting:
A large urban, academic tertiary center, located in the greater New York metropolitan area.
Participants:
Patients 65 years and older hospitalized for operative hip fracture. Those with pathologic or periprosthetic fractures and chronic substance use were excluded.
Main Outcome Measurements:
Outcome measures included time to operating room (TtOR), length of stay, daily and total morphine milligram equivalents, use of preoperative transthoracic echocardiogram and blood transfusions, perioperative complications (eg, urinary tract infections), and 6-month mortality.
Results:
Our study included 290 patients hospitalized with hip fracture, before (N = 128) and after (N = 162) implementation. When compared with the preimplementation group, the postimplementation comanagement group had a lower TtOR (36.2 vs. 30.0 hours, P = 0.026) and hospital length of stay, decreased use of indwelling bladder catheters preoperatively and postoperatively (68.0% vs. 46.9%, P < 0.001, and 83.6 vs. 58.0%, P < 0.001, respectively), reduced daily opiate use (16.0 vs. 11.1 morphine milligram equivalents, P = 0.011), and decreased 30-day complications (32.8% vs. 16.7%, P = 0.002). There was no difference in 6-month mortality between the 2 groups.
Conclusions:
The implementation of an AGS CoCare:Ortho-based comanagement program led to decreased perioperative complications and resource utilization. Comanagement programs are essential to improving and standardizing hip fracture care for older adults.
Level Of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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