Two surgical pathways for isolated hip fractures: A comparative study

Alexander A Fokin; Joanna Wycech Knight; Maral Darya; Ryan Stalder; Ivan Puente; Russell D Weisz

doi:10.5312/wjo.v14.i6.399

Two surgical pathways for isolated hip fractures: A comparative study

World J Orthop. 2023 Jun 18;14(6):399-410. doi: 10.5312/wjo.v14.i6.399.

Authors

Alexander A Fokin^{1

2}, Joanna Wycech Knight^{1

3}, Maral Darya^{1

4}, Ryan Stalder^{1

4}, Ivan Puente^{1

5

3

6}, Russell D Weisz^{1

7}

Affiliations

¹ Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States.
² Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States. alexander.fokin@tenethealth.com.
³ Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States.
⁴ Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States.
⁵ Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States.
⁶ Department of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, United States.
⁷ Department of Orthopedics, South Palm Orthopedics, Delray Beach, FL 33445, United States.

Abstract

Background: Hip fractures (HF) are common among the aging population, and surgery within 48 h is recommended. Patients can be hospitalized for surgery through different pathways, either trauma or medicine admitting services.

Aim: To compare management and outcomes among patients admitted through the trauma pathway (TP) vs medical pathway (MP).

Methods: This Institutional Review Board-approved retrospective study included 2094 patients with proximal femur fractures (AO/Orthopedic Trauma Association Type 31) who underwent surgery at a level 1 trauma center between 2016-2021. There were 69 patients admitted through the TP and 2025 admitted through the MP. To ensure comparability between groups, 66 of the 2025 MP patients were propensity matched to 66 TP patients by age, sex, HF type, HF surgery, and American Society of Anesthesiology score. The statistical analyses included multivariable analysis, group characteristics, and bivariate correlation comparisons with the χ² test and t-test.

Results: After propensity matching, the mean age in both groups was 75-years-old, 62% of both groups were females, the main HF type was intertrochanteric (TP 52% vs MP 62%), open reduction internal fixation was the most common surgery (TP 68% vs MP 71%), and the mean American Society of Anesthesiology score was 2.8 for TP and 2.7 for MP. The majority of patients in TP and MP (71% vs 74%) were geriatric (≥ 65-years-old). Falls were the main mechanism of injury in both groups (77% vs 97%, P = 0.001). There were no significant differences in pre-surgery anticoagulation use (49% vs 41%), admission day of the week, or insurance status. The incidence of comorbidities was equal (94% for both) with cardiac comorbidities being dominant in both groups (71% vs 73%). The number of preoperative consultations was similar for TP and MP, with the most common consultation being cardiology in both (44% and 36%). HF displacement occurred more among TP patients (76% vs 39%, P = 0.000). Time to surgery was not statistically different (23 h in both), but length of surgery was significantly longer for TP (59 min vs 41 min, P = 0.000). Intensive care unit and hospital length of stay were not statistically different (5 d vs 8 d and 6 d for both). There were no statistical differences in discharge disposition and mortality (3% vs 0%).

Conclusion: There were no differences in outcomes of surgeries between admission through TP vs MP. The focus should be on the patient's health condition and on prompt surgical intervention.

Keywords: Admitting service; American Society of Anesthesiologists score; Isolated hip fractures; Preoperative consultations; Time to surgery; Trauma center.