Assessing Impact of Orthopedic Subspecialty Training on Outcomes of Non-Arthroplasty Fixation of Geriatric Hip Fractures

Abstract

Purpose In a single health system (NYU Langone Health) with established management protocols, our study examined differences in postoperative outcomes among patients treated with non-arthroplasty hip fracture fixation by orthopedic trauma (OT), adult reconstruction (AR), and sports medicine (SM) subspecialists. Materials and Methods We performed a retrospective review of 1,588 geriatric patients who underwent internal fixation for a hip fracture using a standard perioperative treatment protocol. Patients were assessed for in-hospital outcomes as well as readmissions and complications. Results Race/ethnicity, American Society of Anesthesiologists classification, ambulatory status, and energy of injury differed among subspecialty cohorts. The 30- and 90-day readmission rates were higher in the AR group than in the OT group (P=0.001, P=0.028). However, these differences were no longer significant after adjusting for baseline health, fracture type, and surgical construct. Mortality during admission, fracture-related infections, and revision surgery did not differ significantly across the 3 groups. Although the difference in the length of stay (LOS) (<1 day) across the groups was statistically significant (P=0.004), it was not clinically meaningful in adjusted analyses. Conclusion Within standardized care pathways, short-term outcomes did not meaningfully differ by fellowship background after adjustment. Surgical experience and consistency in care may be more influential, and future studies should account for surgeon case volume.