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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Alexander A Fokin, Joanna Wycech Knight, Maral Darya, Ryan Stalder, Ivan Puente, Russell D Weisz, Trauma and Critical Care Services, Delray Medical Center, Delray Beach, FL 33484, United States
Alexander A Fokin, Ivan Puente, Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
Joanna Wycech Knight, Ivan Puente, Trauma and Critical Care Services, Broward Health Medical Center, Fort Lauderdale, FL 33316, United States
Maral Darya, Ryan Stalder, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, United States
Ivan Puente, Department of Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, United States
Russell D Weisz, Department of Orthopedics, South Palm Orthopedics, Delray Beach, FL 33445, United States
Author contributions: Fokin AA and Weisz RD conceptualized the research study; Fokin AA, Wycech Knight J, Puente I, and Weisz RD designed the methodology; Fokin AA, Puente I, and Weisz RD were the project administrators and supervisors; Wycech Knight J, Darya M, and Stalder R performed the research; Wycech Knight J performed the software analysis; Fokin AA, Wycech Knight J, Darya M, Stalder R, Puente I, and Weisz RD performed formal data analysis and validation; Fokin AA, Wycech Knight J, Darya M, and Stalder R wrote the original draft of the manuscript; Fokin AA, Wycech Knight J, Darya M, Stalder R, Puente I, and Weisz RD performed manuscript review and editing; and all authors read and approved the final manuscript.
Institutional review board statement: This study was approved by the MetroWest Institutional Review Board, Framingham, MA under the protocol number: #2020-138.
Informed consent statement: This retrospective study was granted a waiver of informed consent by the MetroWest Institutional Review Board.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: Deidentified data and study materials are available upon reasonable request from the corresponding author at alexander.fokin@tenethealth.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Alexander A Fokin, Doctor, MD, Professor, Researcher, Trauma and Critical Care Services, Delray Medical Center, 5352 Linton Blvd, Delray Beach, FL 33484, United States. alexander.fokin@tenethealth.com
Received: December 13, 2022
Peer-review started: December 13, 2022
First decision: March 14, 2023
Revised: March 22, 2023
Accepted: April 27, 2023
Article in press: April 27, 2023
Published online: June 18, 2023
ARTICLE HIGHLIGHTS
Research background
Isolated hip fractures (HF) are common, especially among the elderly population, and falls are the main mechanism of injury. Depending on the hospital settings and institutional policies, patients can be admitted for surgery through different pathways (medicine or trauma). There is a scarcity of studies utilizing the propensity score matching methodology in the analysis of the data on this subject.
Research motivation
It has been reported that the admitting service may influence the outcomes of patients with HF. The motivation behind this study were the conflicting conclusions and ongoing debates over which admitting service is associated with better results. We hypothesized that it is necessary to contribute new data and a new outlook to help achieve improvements in the treatment of patients with HF.
Research objectives
To analyze the characteristics and compare the outcomes of similarly injured patients with HF admitted through trauma vs medicine service at an urban level 1 trauma center.
Research methods
This was a retrospective cohort study. Patients with HF were divided into two groups based on the admitting service: Trauma vs medicine. Propensity score matching was utilized to ensure comparability between the groups. Patients were propensity matched by age, sex, HF type and surgery, and the American Society of Anesthesiology score. The statistical analyses included group characteristics, bivariate correlation comparisons, multivariable analysis, and one way analysis of variance.
Research results
Time to surgery, time in the intensive care unit, hospital length of stay, discharge disposition, and mortality were not statistically different between the two groups. The average number of preoperative consultations was similar in both groups with cardiology consultation being the most common. Higher American Society of Anesthesiology score was associated with a longer hospital stay and mortality.
Research conclusions
The health condition of the patient, but not the admission pathway, is the defining factor in the management and outcomes of patients with HF.
Research perspectives
Research should be conducted across multiple medical centers to include larger cohorts with more focus on predictors of adverse outcomes as well as the potential cost differences between the admission pathways.
