Variations in hip fracture management at trauma vs. non-trauma centers

Hip fractures represent a growing public health burden. Optimal management relies on timely surgical intervention coordinated by multidisciplinary care and appropriate resource availability, all of which may vary between hospital settings. Differences between trauma hospitals and non-trauma hospitals may influence outcomes, yet these variations have not been well characterized.

We conducted a retrospective cohort study of hip fracture cases over a 2-year period (October 2022 to August 2024), comparing patient and procedural characteristics between a Level II trauma hospital (TH) (n = 104) and a non-trauma hospital (NTH) (n = 31). Polytrauma patients were excluded. Data were extracted from the electronic medical record (EMR). Primary outcomes were hospital length of stay (LOS) and time from admission to surgery. Group comparisons utilized chi-square or Fisher's exact tests for categorical variables and Mann-Whitney U or Welch t-tests for continuous variables, as appropriate. A multivariable random forest model was used to evaluate predictors of operative duration.

ASA physical status distribution differed significantly between facilities (p = 0.03), with more ASA > 2 patients at the NTH (76.6% vs. 65.7%). Osteosynthesis was performed in 73.3% of NTH cases and 82.2% of TH cases; arthroplasty comprised 26.7% and 17.8%, respectively. LOS differed significantly by facility (p < 0.01), with a shorter mean stay at the NTH (4.3 vs. 5.9 days; mean difference, -1.73 days). Time to surgery also differed significantly (p < 0.001): mean 846 min (95% CI, 615-1078) at the NTH vs. 2686 minutes (95% CI, 2391-2981) at the TH. In multivariable modeling, procedure type was the dominant predictor of operative duration (permutation importance 0.686), followed by payer type (0.216); facility identity contributed minimally (0.034) after accounting for case mix.

Hip fracture care differed meaningfully between the TH and NTH within the same health care system. The NTH demonstrated significantly shorter time to surgery and LOS despite treating a proportionally higher-acuity patient population by ASA classification. These findings highlight opportunities for optimizing timeliness and resource allocation in hip fracture management across hospital settings and questions whether THs are the optimal location to treat these injuries.