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

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Purpose: 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: 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: 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: 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.

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