Predictive Scoring Methods for Postoperative Level of Care Needs in the Geriatric Hip Fracture Patient Population

This study's purpose was to use a postoperative ICU geriatric prediction score (PIGS) to determine the appropriateness of postoperative ICU/SDU admission or unnecessary use of advanced care services in geriatric femur fracture patients at our Level III trauma center.

This is a retrospective review of 142 patients, age 65 years or older, at a level III trauma center from 3/2021-9/2022 that required surgical fixation of a femur fracture. Collected data included demographics, injury characteristics, postoperative complications, hospital charges, and admission to ICU or SDU.

Average age was 81.5 years. 32% of patients were male and 40% were femoral neck fractures. The average PIGS score was 7.1. 17% of patients admitted to the SDU met the PIGS threshold for ICU transfer. 7% were transferred to the ICU after being admitted to the SDU postoperatively, 0% of whom met criteria for ICU admission at the level 1 trauma center. Predictive factors for their transfer to the ICU at the level 3 trauma center was postoperative blood transfusion (OR:4.11;CI 1.09,15.45;P = 0.036) and history of cancer or organ transplant (OR:5.86;CI 1.2926.58; P = 0.022). Predictive factor of postoperative death (aside from transfer to ICU) was a history of cancer or organ transplant (OR:13.90;CI 7.65,25.25;P = 0.007). Average gross charges per patient admitted to the floor and the SDU were $80,383 and $82,590, respectively,P = 0.372.

The geriatric population with a femur fracture is often unnecessarily admitted to advanced care units postoperatively. The PIGS system has been validated for use in a level 1 trauma center in the geriatric population undergoing hip fracture surgery. Here, we validate its use in the geriatric population undergoing femur fracture surgery at a level III trauma center, where majority of patients may not meet the criteria for advanced care and could be cared for more cost-effectively.