Is selective hospitalist–orthopedic surgeon co-management based on the Charlson comorbidity index useful in peri-operative care of total hip arthroplasty?

Abstract

Purpose

Total hip arthroplasty (THA) is an effective treatment for hip diseases, but peri-operative management of patients with multiple comorbidities is challenging due to an increased risk of medical complications. Hospitalist–orthopedic surgeon co-management (HOC) has been reported to improve peri-operative care, but its effectiveness and impact on healthcare resources remain uncertain. This prospective, single-center study evaluated the utility of selective HOC based on the Charlson comorbidity index (CCI) in THA peri-operative management.

Methods

This study included 90 consecutive cases with primary THA by a single orthopedic surgeon. Based on CCI, patients were divided into an HOC group (CCI score ≥2) and non-HOC group (CCI score <2). The HOC group received peri-operative care from a hospitalist and orthopedic surgeon, while non-HOC group was managed by an orthopedic surgeon alone. Medical and surgery-related complications, hospital length of stay, 30-day mortality, and costs were evaluated.

Results

There were 17 cases (19%) in the HOC group and 73 (81%) in non-HOC group. The mean CCI score was 3.1 ​± ​1.3 in the HOC group and 0.4 ​± ​0.5 in the non-HOC group. Medical complications were more frequent in the HOC group (35% vs. 4%), while surgery-related complications were comparable. No statistically significant difference was observed in length of stay, 30-day mortality, and costs.

Conclusions

Selective indication for HOC based on CCI effectively identified high-risk patients, enabling timely intervention for medical complications without prolonging hospital stay. This strategy may mitigate peri-operative medical risks while optimizing resource use.