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The impact of pre- versus postoperative geriatric consultation in elderly patients with hip fractures
Fatmanur B Aydin1,2,3, Duco W P M Laane4,5,6,7, Annemarie van Rossum du Chattel4,5,6
1Division of Orthopaedic Trauma, Department of Orthopaedics, Brigham and Women's Hospital, Boston, MA, USA. f.aydin@antoniusziekenhuis.nl.
Purpose:
To determine whether preoperative geriatric consultation was independently associated with lower incidence of delirium for elderly patients with hip fractures compared with postoperative geriatric consultation.
Methods:
This retrospective cohort study was conducted at two urban Level 1 trauma centers in the United States. Patients aged ≥ 70 years with isolated proximal femur fractures treated surgically between 2018 and 2024 were included. Patients with pathological or periprosthetic fractures, non-orthopedic admissions, and those without geriatric consultation were excluded. Patients were categorized based on timing of initial geriatric consultation: preoperative versus postoperative. Delirium was selected as the primary outcome because geriatric consultation most directly addresses modifiable delirium risk factors. Secondary outcomes included the incidence of one or more in-hospital complications, length of stay, 30-day all-cause readmissions, and mortality. Multivariable logistic and linear regression analyses were used to determine the independent association between timing of initial geriatric consultation and primary and secondary outcomes.
Results:
Of 1776 patients included, 1382 (78%) received initial geriatric consultation preoperatively and 394 (22%) postoperatively. Median age was 84 years (IQR 78-90), 70% were female, 73% ASA III, and 87% lived at home pre-admission. Delirium occurred in 19.7% in the preoperative vs. 19.5% in the postoperative groups. After adjustment, consultation timing was not independently associated with delirium (aOR = 1.09, 95%-CI = 0.81-1.47, p=.567).
Conclusions:
Preoperative versus postoperative initial geriatric consultation was not independently associated with delirium incidence and produced comparable short-term clinical outcomes.
Level Of Evidence:
Prognostic Level III.