Copyright
©The Author(s) 2023.
World J Orthop. Jun 18, 2023; 14(6): 399-410
Published online Jun 18, 2023. doi: 10.5312/wjo.v14.i6.399
Published online Jun 18, 2023. doi: 10.5312/wjo.v14.i6.399
Table 1 General comparison between all trauma pathway and medical pathway patients, n (%)
| Variable | Trauma, n = 69 | Medicine, n = 2025 | P value |
| Age in yr | 72.9 (17.5) | 83.2 (9.2) | 0.000a |
| Geriatric | 47 (68.1) | 1928 (95.2) | 0.000a |
| Sex, female/male | 44 (63.8)/25 (36.2) | 1367 (67.5)/658 (32.5) | 0.515 |
| Mechanism of injury | - | - | 0.000a |
| Fall | 51 (73.9) | 2005 (99.0) | - |
| MVC | 18 (26.1) | 11 (0.5) | - |
| Stress fracture | 0 (0.0) | 9 (0.4) | - |
| Admission day | - | - | 0.171 |
| Monday | 10 (14.5) | 317 (15.7) | - |
| Tuesday | 12 (17.4) | 281 (13.9) | - |
| Wednesday | 16 (23.2) | 268 (13.2) | - |
| Thursday | 5 (7.2) | 311 (15.4) | - |
| Friday | 10 (14.5) | 297 (14.7) | - |
| Saturday | 7 (10.1) | 276 (13.6) | - |
| Sunday | 9 (13.0) | 275 (13.6) | |
| Hip fracture type | - | - | 0.000a |
| Femoral neck/head | 28 (40.6) | 972 (48.0) | - |
| Intertrochanteric | 35 (50.7) | 1020 (50.4) | - |
| Intertrochanteric with subtrochanteric | 6 (8.7) | 33 (1.6) | - |
| Hip surgery type | - | - | 0.205 |
| Total arthroplasty | 4 (5.8) | 177 (8.7) | - |
| Hemi arthroplasty | 15 (21.7) | 613 (30.3) | - |
| Open reduction and internal fixation | 47 (68.1) | 1116 (55.1) | - |
| Pinning | 3 (4.3) | 119 (5.9) | - |
| ASA score before hip surgery | 2.8 (0.6) | 2.9 (0.6) | 0.044a |
| ASA score before hip surgery | - | - | 0.079 |
| I | 1 (1.4) | 9 (0.4) | - |
| II | 21 (30.4) | 393 (19.4) | - |
| III | 41 (59.4) | 1393 (68.8) | - |
| IV | 6 (8.7) | 230 (11.4) | - |
| No. of consultations before hip surgery | 0.9 (0.9) | 0.9 (0.8) | 0.620 |
| Time: Admission to hip surgery in h | 23.0 (13.4) | 27.0 (28.5) | 0.255 |
| Hospital length of stay in d | 6.3 (4.4) | 5.7 (4.9) | 0.347 |
| Mortality | 2 (2.9) | 62 (3.1) | 0.938 |
| Hospital disposition | - | - | 0.068 |
| Skilled nursing facility | 28 (40.6) | 1147 (56.6) | - |
| Rehabilitation | 25 (36.2) | 589 (29.1) | - |
| Home | 13 (18.8) | 212 (10.5) | - |
| Hospice | 1 (1.4) | 51 (2.5) | - |
| Expired in hospital | 1 (1.4) | 11 (0.5) | - |
| Long-term acute care facility | 1 (1.4) | 15 (0.7) | - |
Table 2 Characteristics of propensity matched patients admitted through the trauma pathway and medical pathways, n (%)
| Variable | Trauma, n = 66 | Medicine, n = 66 | P value |
| Age | 75.0 (14.5) | 75.0 (13.3) | 0.990 |
| Sex, female/male | 41 (62.1)/25 (37.9) | 41 (62.1)/25 (37.9) | 1.000 |
| ASA Score before hip surgery | - | - | 0.498 |
| II | 19 (28.8) | 23 (34.8) | - |
| III | 41 (62.1) | 40 (60.6) | - |
| IV | 6 (9.1) | 3 (4.5) | - |
| Hip fracture type | - | - | 0.057 |
| Femoral neck/head | 27 (40.9) | 25 (37.9) | - |
| Intertrochanteric | 34 (51.5) | 41 (62.1) | - |
| Intertrochanteric with subtrochanteric | 5 (7.6) | 0 (0.0) | - |
| Hip surgery type | - | - | 0.650 |
| Total arthroplasty | 4 (6.1) | 6 (9.1) | - |
| Hemi arthroplasty | 15 (22.7) | 10 (15.2) | - |
| Open reduction and internal fixation | 45 (68.2) | 47 (71.2) | - |
| Pinning | 2 (3.0) | 3 (4.5) | - |
| Geriatric | 47 (71.2) | 49 (74.2) | 0.696 |
| BMI | 24.9 (6.6) | 24.9 (5.0) | 0.988 |
| Comorbidities | 62 (93.9) | 62 (93.9) | 1.000 |
| Cardiac comorbidities | 47 (71.2) | 48 (72.7) | 0.846 |
| Anticoagulation | 32 (48.5) | 27 (40.9) | 0.381 |
| Mechanism of injury, Fall/MVC | 51 (77.3)/15 (22.7) | 64 (97.0)/2 (3.0) | 0.001a |
| Admission day | - | - | 0.401 |
| Monday | 9 (13.6) | 7 (10.6) | - |
| Tuesday | 11 (16.7) | 8 (12.1) | - |
| Wednesday | 16 (24.2) | 10 (15.2) | - |
| Thursday | 5 (7.6) | 12 (18.2) | - |
| Friday | 10 (15.2) | 13 (19.7) | - |
| Saturday | 7 (10.6) | 10 (15.2) | - |
| Sunday | 8 (12.1) | 6 (9.1) | - |
| Glasgow coma score | 14.6 (0.8) | 15.0 (0.2) | 0.000a |
| Hip fracture displacement | 50 (75.8) | 26 (39.4) | 0.000a |
| No. of consultations before hip surgery | 1.8 (0.9) | 1.7 (0.9) | 0.198 |
| Consultations before surgery | - | - | - |
| Cardiology | 29 (43.9) | 24 (36.4) | 0.375 |
| Neurology/neurosurgery | 12 (18.2) | 1 (1.5) | 0.001a |
| Pulmonology | 2 (3.0) | 5 (7.6) | 0.244 |
| Time: Admission to hip surgery in h | 22.7 (12.7) | 23.0 (16.9) | 0.892 |
| Orthopedic surgery length in h | 1.0 (0.6) | 0.7 (0.3) | 0.000a |
| ICULOS in d | 4.5 (4.3) | 8.0 (4.6) | 0.066 |
| HLOS in d | 6.3 (4.5) | 6.0 (5.4) | 0.709 |
| Mortality | 2 (3.0) | 0 (0.0) | 0.154 |
| Hospital disposition | - | - | 0.507 |
| Skilled nursing facility | 29 (43.9) | 31 (47.0) | - |
| Rehabilitation | 29 (43.9) | 26 (39.4) | - |
| Home | 6 (9.1) | 9 (13.6) | - |
| Expired in hospital/hospice | 2 (3.0) | 0 (0.0) | - |
| Insurance status | - | - | 0.060 |
| Public | 48 (72.7) | 47 (71.2) | - |
| Private | 10 (15.2) | 17 (25.8) | - |
| Uninsured | 8 (12.1) | 2 (3.0) | - |
Table 3 Mean age and hospital length of stay stratified by American Society of Anesthesiologists score, n (%)
| ASA, score | All patients, n = 2094 | Propensity matched trauma group, n = 66 | Propensity matched medicine group, n = 66 | ||||||
| n % | Age, mean | HLOS, mean | n | Age, mean | HLOS, mean | n | Age, mean | HLOS, mean | |
| 1 | 10 (0.5) | 65.0 | 5.3 | - | - | - | - | - | - |
| 2 | 414 (19.8) | 77.1 | 4.7 | 19 | 65.6 | 5.8 | 23 | 74.0 | 5.7 |
| 3 | 1434 (68.5) | 84.1 | 5.7 | 41 | 77.5 | 6.5 | 40 | 76.4 | 6.3 |
| 4 | 236 (11.3) | 85.8 | 7.5 | 6 | 87.7 | 6.9 | 3 | 64.0 | 4.4 |
- Citation: Fokin AA, Wycech Knight J, Darya M, Stalder R, Puente I, Weisz RD. Two surgical pathways for isolated hip fractures: A comparative study. World J Orthop 2023; 14(6): 399-410
- URL: https://www.wjgnet.com/2218-5836/full/v14/i6/399.htm
- DOI: https://dx.doi.org/10.5312/wjo.v14.i6.399