In elderly patients with hip fracture, a hospitalist model decreased time to surgery, time from surgery to dismissal, and length of stay without adversely affecting inpatient deaths or 30-day readmission rates.

BACKGROUND We previously demonstrated that a hospitalist service created to medically manage patients with hip fracture reduced time to surgery and length of hospital stay, with no difference in inpatient mortality, compared with patients who received standard care. Whether this improved efficiency affects long‐term mortality is unknown. OBJECTIVE This study examined the effects of this hospitalist service versus standard care on mortality up to 1 year and identified predictors of mortality in patients with hip fracture. DESIGN Retrospective cohort study. SETTING Tertiary care center. PATIENTS Four hundred and sixty‐six consecutive patients admitted for surgical repair of a hip fracture in 2000–2002 with 93% 1‐year follow‐up. RESULTS There was no significant difference in survival of the patients between those on the hospitalist care service and those on the standard care service (70.5% [CI: 64.8%, 76.7%] vs. 70.6% [CI: 64.9%, 76.8%]; P = .36), despite the shortened time to surgery and decreased length of stay in the hospitalist group. Predictors of mortality included: admission from a nursing home (hazard ratio [HR] 2.24, [CI: 1.73, 2.90]); age at admission (HR 1.17 [CI: 0.99, 1.38]); inpatient complications, including ICU admission, myocardial infarction, or acute renal failure (HR 1.85 [CI: 1.45, 2.35]); and ASA class III or IV compared with ASA class II (HR 4.20 [CI: 2.21, 7.99]). CONCLUSIONS The improved efficiency in reducing length of stay and time to surgery in the hospitalist group did not adversely affect long‐term mortality of this patient population. Journal of Hospital Medicine 2007;2:219–225. © 2007 Society of Hospital Medicine.

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Background/Objectives To quantify the occurrence of myocardial infarction (MI) occurring in the early postoperative period following surgical hip fracture repair and estimate the impact on one-year mortality. Design This study is a population-based, historical cohort study of patients who underwent surgical repair of a hip fracture. This studyutilized the computerized medical record linkage system of the Rochester Epidemiology Project. Setting Academic and community hospitals, outpatient offices and nursing homes in Olmsted County, Minnesota. Participants In the 15-year study period (1988–2002), 1116 elderly patients underwent surgical repair of a hip fracture. Measurements At the end of the first seven days following hip fracture repair, patients were classified into one of three groups: clinically verified MIs (cv-MI), subclinical myocardial ischemia (sc-MI) and no myocardial ischemia. One-year mortality was compared between these groups. Multivariate models assessed risk factors for early postoperative cv-MI and one-year mortality, respectively. Results Within the first seven days following hip fracture repair, 116 (10.4%) patients experienced cv-MIs and 41 (3.7%) had sc-MIs. Overall 1-year mortality rate was 22% and there was no difference between those with sc-MIs and those with nomyocardial ischemia. One-year mortality for those with cv-MI was significantly higher than the other two groups (35.8%). Occurrence of early postoperative cv-MI, male gender, and histories of heart failure or dementia were independently associated with increased one-year mortality; while, pre-fracture home residence and preoperative higher hemoglobin were protective. Conclusion Early postoperative, clinically verified, MIs following hip fracture repair exceeds rates following other major orthopedic surgeries and is independently associated with increased one-year mortality.