Original Research
Admitting Service and Morbidity and Mortality in Elderly Patients After Hip Fracture: Finding a Threshold for Medical Versus Orthopedic Admission
Am J Orthop. 2010 February;39(2):80-87
Author and Disclosure Information
James M. Mok, MD, Salim K. Durrani, MS, Akira Yamamoto, MD, and Hubert T. Kim, MD, PhD
Dr. Mok is Resident, Mr. Durrani is Visiting Medical Student, Dr. Yamamoto is Resident, and Dr. Kim is Associate Professor in Residence, Department of Orthopaedic Surgery, University of California, San Francisco, California
Outcomes by admitting service of 355 consecutive patients admitted for hip fracture at an academic medical center were retrospectively studied. An adverse event occurred in 53 patients (14.9%): 10 in-hospital deaths, 37 intensive care unit transfers, and 25 deaths within 30 days. No significant difference was found between percentages of patients with adverse events admitted to a medical service versus an orthopedic service (52.8% vs 47.2%; P = .8). Criteria that determine admitting service based on medical acuity do not adequately allocate patients at risk for serious morbidity and early mortality to a medical service. Addition of American Society of Anesthesiologists grade 4 and men 85 or older to existing criteria would increase the percentage of patients with adverse events admitted to a medical service (72% vs 28%; P<.005).