Admitting Geriatric Hip Fracture Patients to the Orthopaedic Service Decreases Cost of Care
Nicole A. Zelenski, John Logan Brock, Ryan D. DeAngelis, Ryan S. Charette, Alexander L. Neuwirth, Samir MehtaIntroduction
Hip fractures are common and costly, costing $12 billion annually in the US. A large portion of the cost of care is related to inpatient care, which is highly variable. There is a lack of strong evidence regarding whether medicine or orthopaedics should serve as the primary admitting and managing service in the care of hip fracture patients with neither having improved outcomes. The purpose of this study is to compare the cost of care between patients who were admitted to orthopaedic vs. non-orthopaedic services after geriatric hip fractures.
Methods
A retrospective chart review was conducted of patients over the age of 55 with hip fractures undergoing operative treatment at a Level 1 trauma center between 2010-2013. We examined demographic information, admitting service (orthopaedic vs. non-orthopaedic), length of stay, ASA score as well as reimbursement and cost information. Statistical analysis was performed to evaluate what factors most influence cost of care.
Results
A total of 326 patients with hip fractures were included in the analysis. After controlling for age, sex, BMI, and ASA score, admission to the orthopaedic service was associated with $3,172 lower total costs than admission to a non-orthopaedic service (p=0.0001). Patients admitted to the orthopaedic service were discharged an average of 2.6 days earlier than patients on the non-orthopaedic service (p<0.0001). There was no difference in 30-day readmission or 90-day mortality between the two groups.
Discussion
Hip fracture patients admitted to the orthopaedic service are discharged sooner than patients admitted to a non-orthopaedic service, even when controlling for ASA score. Nationally, this implies substantial potential cost savings from admitting patients to orthopaedic rather than non-orthopaedic services. Systems should develop clear guidelines on when it is appropriate to admit hip fracture patients to non-orthopaedic services, and the orthopaedic service should be the default admitting service.