Medical comanagement did not improve hip fracture outcomes


Background: Medical comanagement of hip fracture patients is common. Prior evidence comes from mostly single-center studies, with most improvements being in process indicators such as length of stay and staff satisfaction.

Dr. Sean M. Lockwood

Study design: Retrospective cohort study.

Setting: American College of Surgeons National Surgical Quality Improvement Program database.

Synopsis: With the NSQIP database targeted user file for hip fracture of 19,896 patients from 2016 to 2017, unadjusted analysis showed patients in the medical comanagement cohort were older with higher burden of comorbidities, higher morbidity (19.5% vs. 9.6%, odds ratio, 2.28; 95% CI, 1.98-2.63; P < .0001), and higher mortality rate (6.9% vs. 4.0%; OR, 1.79; 95% CI, 1.44-2.22; P < .0001). Both cohorts had similar proportion of patients participating in a standardized hip fracture program. After propensity score matching, patients in the comanagement cohort continued to show inferior morbidity (OR, 1.82; 95% CI, 1.52-2.20; P < .0001) and mortality (OR, 1.36; 95% CI, 1.02-1.81; P = .033).

This study failed to show superior outcomes in comanagement patients. The retrospective nature and propensity matching will lead to the question of unmeasured confounding in this large multinational database.

Bottom line: Medical comanagement of hip fractures was not associated with improved outcomes in the NSQIP database.

Citation: Maxwell BG, Mirza A. Medical comanagement of hip fracture patients is not associated with superior perioperative outcomes: A propensity score–matched retrospective cohort analysis of the National Surgical Quality Improvement Project. J Hosp Med. 2020;15:468-74.

Dr. Lockwood is a hospitalist and chief of quality, performance, and patient safety at the Lexington (Ky.) VA Health Care System.

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