Orthogeriatric Co-Management Improves Early Outcomes in Hip Fractures: A Post-Hoc Analysis of a Prospective Study.

Purpose: To assess the effect of orthogeriatric co-management care on the geriatric hip fracture patients with high ASA score. Patients and Methods: A post-hoc analysis of a prospective multicenter study was done. Patients with an ASA score of 3 or 4 were selected from the database for analysis. Patients were divided into the orthogeriatric co-management group (CM group) and traditional consultation mode group (TC group) depending on the management mode. With mortality as the primary outcome, multivariate regression analyses were performed to adjust for confounders. Mobility and quality of life were compared between groups. Results: A total of 628 patients were included, 593 of whom completed follow-up (388 in CM group, 205 in TC group). The in-hospital mortality, 30-day mortality, 120-day mortality in CM group were significantly lower than those in TC group after adjustment (P < 0.05). The difference of 1-year mortality in the two groups was not statistically significant after adjustment (P > 0.05). The surgical intervention rate, the early surgery rate, preoperative waiting time, hospital length of stay (LOS), 30-day mobility, 30-day EuroQol-5 Dimensions (EQ-5D) index, 30-day EuroQol-Visual Analog Scale (EQ-VAS), 120-day EQ-5D index, the total incidence of clinical adverse events, as well as deep vein thrombosis (DVT) and cardiac complication between the two groups were statistically significantly different after adjustment (P < 0.05). The difference of 120-day mobility was not statistically significant after adjustment (P < 0.05). There was no significant difference in the in-hospital total cost, the incidence of other clinical adverse events, 120-day EQ-VAS, 1-year reoperation rate, 1-year mobility, 1-year EQ-5D index, 1-year EQ-VAS between the two groups (P > 0.05). Conclusion: Compared with the traditional consultation mode, orthogeriatric co-management care significantly reduced early mortality and enhanced early mobility and quality of life in geriatric hip fracture patients with high ASA score.