Impact of New Orthopaedic Surgery Residency on Hip Fracture Time to Fixation at Rural Level 1 Trauma Center.

Abstract

Introduction: Hip fractures are among the most common orthopaedic injuries and are a vital element of orthopaedic surgery residency training. Multiple studies have examined resident involvement on surgical time, length of stay (LOS), cost, and outcomes. This study compared the time from orthopaedic hip fracture consultation to operative fixation before and after implementation of a new orthopaedic residency at a rural community hospital.

Methods: A retrospective review of electronic medical records was performed for patients who underwent surgical fixation of a hip fracture from July 2019 to June 2023. July 2019 to June 2021 represented the period before orthopaedic residents, and July 2021 to June 2023 represented the period with orthopaedic resident involvement. The primary outcome was time from hip fracture consult order to patient entry into the operating room (OR) before and after resident involvement. Secondary outcomes included LOS, 30-day readmission rate, and 90-day return to the emergency department.

Results: In total, 821 hip fractures underwent operative fixation between July 2019 and June 2023: 387 (47.1%) were performed before resident involvement and 434 (52.9%) were performed after initiation of the orthopaedic residency. There was no statistically significant difference in time to OR from consult before and after resident involvement (28.3 vs. 27.8 hours, p = 0.786), LOS (6.4 vs. 6.1 days, p = 0.33), 30-day readmission rate (12.1% vs. 9.9%, p = 0.362), or 90-day return to the emergency department (26.1% vs. 27.4%, p = 0.728).

Conclusion: Timely hip fracture fixation within 24 to 48 hours is essential for optimal patient outcomes. This study demonstrates that the introduction of orthopaedic surgery residents does not compromise timely operative fixation, LOS, or readmission rates in patients with hip fractures.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.