Outcome Disparities in Geriatric Hip Fracture: Orthogeriatric Co‐Management Versus Internal Medicine Admission
Noah Stevens, Jessica Chao, Maggie Fagan, Brandon Wang, Pamela Zuckerman, Yungtai Lo, Wanda Horn, Vafa Tabatabaie, Mani KahnABSTRACT
Background
Hip fracture carries substantial morbidity and mortality in older adults. Orthogeriatric co‐management has emerged as the evidence‐based standard of care, yet the influence of admitting service on outcomes at institutions where such programs exist remains poorly characterized.
Participants and Setting
Patients aged 65 or older who underwent operative management of hip fractures at an urban academic safety‐net institution between January 2019 and December 2022. After excluding patients admitted to other services or requiring intensive care, the final cohort comprised 443 patients (349 orthogeriatric co‐management, 94 internal medicine).
Methods
This retrospective cohort study compared outcomes between patients admitted to an orthogeriatric co‐management service versus internal medicine. Internal medicine patients received no formal geriatric involvement. Univariate logistic regression assessed associations between admitting service and binary outcomes. Multivariable logistic regression for 1‐year mortality adjusted for age, sex, and ASA score. A matched analysis paired patients 1:1 on ASA score, sex, and age within 3 years using McNemar and Wilcoxon signed‐rank tests.
Results
Baseline characteristics were comparable between groups, including ASA score, age, comorbidity burden, and fracture type. Internal medicine admission was associated with higher 1‐year mortality (OR: 3.01, 95% CI: 1.53–5.83, p = 0.001), greater surgical delay beyond 24 h (OR: 3.16, 95% CI: 1.98–5.12, p < 0.001), longer length of stay (p < 0.001), and reduced follow‐up within 3 weeks (OR: 0.32, p < 0.001). In 91 matched pairs, these associations persisted for 1‐year mortality ( p = 0.035), surgical delay ( p < 0.001), follow‐up ( p = 0.003), and length of stay ( p < 0.001). Multivariable analysis of 1‐year mortality was consistent with the univariate and matched analyses (OR: 2.66, 95% CI: 1.32–5.25, p = 0.005).
Conclusions
Admitting service is associated with hip fracture outcomes, and this association was not explained by measured patient complexity. These findings support implementation of service‐agnostic hip fracture protocols ensuring consistent surgical timing and perioperative management regardless of admitting service, particularly when serving high‐risk populations.