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Two surgical pathways for isolated hip fractures: A comparative study
Alexander A Fokin1,2, Joanna Wycech Knight1,3, Maral Darya1,4
1Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States.
Insights
Hip fracture (HF) surgery outcomes were similar regardless of admission via trauma pathway (TP) or medical pathway (MP). Focus on patient health and prompt surgery for optimal results in hip fracture patients.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Trauma Care
Background:
- Hip fractures (HF) are a significant health concern in the aging population.
- Timely surgical intervention, ideally within 48 hours, is crucial for managing hip fractures.
- Patients with hip fractures may be admitted through trauma or medical services.
Purpose of the Study:
- To compare the management and outcomes of hip fracture patients admitted through the trauma pathway (TP) versus the medical pathway (MP.
- To identify any differences in patient characteristics, surgical procedures, and clinical outcomes between the two admission pathways.
Main Methods:
- Retrospective study of 2094 patients with proximal femur fractures (AO/OTA Type 31) undergoing surgery.
- Propensity score matching used to create comparable groups of TP (66 patients) and MP (66 patients).
- Statistical analyses included multivariable analysis, group characteristics, and bivariate correlations (chi-squared and t-tests).
Main Results:
- Matched groups showed no significant differences in age, sex, fracture type, surgical procedure, or ASA score.
- Hip fracture displacement was more common in the TP group (76% vs. 39%).
- Surgery duration was longer for TP patients (59 min vs. 41 min), but time to surgery, ICU/hospital length of stay, and mortality rates were similar between groups.
Conclusions:
- Admission pathway (trauma vs. medical) does not impact hip fracture surgery outcomes.
- Clinical management should prioritize patient health status and expedite surgical intervention.
- Further research could explore specific interventions to mitigate fracture displacement in the trauma pathway.
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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