{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:20:00Z","timestamp":1773966000023,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T00:00:00Z","timestamp":1566345600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Hip fractures typically occur in frail elderly patients. Preoperative specialty consults, in addition to hospitalist comanagement, are often requested for preoperative risk assessment.<\/jats:p><\/jats:sec><jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Determine if preoperative specialty consults meaningfully influence management and outcomes in hip fracture patients, while being comanaged by hospitalists<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN<\/jats:title><jats:p>Retrospective cohort study<\/jats:p><\/jats:sec><jats:sec><jats:title>SETTING<\/jats:title><jats:p>Tertiary care hospital in Connecticut<\/jats:p><\/jats:sec><jats:sec><jats:title>PATIENTS<\/jats:title><jats:p>491 patients aged 50 years and older who underwent surgery for an isolated fragility hip fracture, defined as one occurring from a fall of a height of standing or less.<\/jats:p><\/jats:sec><jats:sec><jats:title>INTERVENTION<\/jats:title><jats:p>Presence or absence of a preoperative specialty consult<\/jats:p><\/jats:sec><jats:sec><jats:title>MEASUREMENTS<\/jats:title><jats:p>Time to surgery (TTS), length of hospital stay (LOS), and postoperative complications<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>177 patients had a preoperative specialty consult. Patients with consults were older and had more comorbidities. Most consult recommendations were minor (72.8%); there was a major recommendation only for eight patients (4.5%). Multivariate analysis demonstrates that consults are more likely to be associated with a TTS beyond 24 hours (Odds Ratio [OR] 4.28 [2.79\u20106.56]) and 48 hours (OR 2.59 [1.52\u20104.43]), an extended LOS (OR 2.67 [1.78\u20104.03]), and a higher 30\u2010day readmission rate (OR 2.11 [1.09\u20104.08]). A similar 30\u2010day mortality rate was noted in both consult and no\u2010consult groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>The majority of preoperative specialty consults did not meaningfully influence management and may have potentially increased morbidity by delaying surgery. Our data suggest that unless a hip fracture patient is unstable and likely to require active management by a consultant, such consults offer limited benefit when weighed against the negative impact of surgical delay.<\/jats:p><\/jats:sec>","DOI":"10.12788\/jhm.3264","type":"journal-article","created":{"date-parts":[[2019,8,26]],"date-time":"2019-08-26T05:49:48Z","timestamp":1566798588000},"page":"16-21","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Impact of Preoperative Specialty Consults on Hospitalist Comanagement of Hip Fracture Patients"],"prefix":"10.1002","volume":"15","author":[{"given":"Nicholas","family":"Bellas","sequence":"first","affiliation":[{"name":"University of Connecticut School of Medicine Farmington Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherry","family":"Stohler","sequence":"additional","affiliation":[{"name":"Hartford Healthcare Bone and Joint Institute Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilene","family":"Staff","sequence":"additional","affiliation":[{"name":"Department of Research Administration Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karolina","family":"Majk","sequence":"additional","affiliation":[{"name":"Hartford Healthcare Bone and Joint Institute Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Courtland","family":"Lewis","sequence":"additional","affiliation":[{"name":"Hartford Healthcare Bone and Joint Institute Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Davis","sequence":"additional","affiliation":[{"name":"Hartford Healthcare Bone and Joint Institute Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mandeep","family":"Kumar","sequence":"additional","affiliation":[{"name":"Hartford Healthcare Bone and Joint Institute Hartford Hospital Hartford Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,8,21]]},"reference":[{"issue":"7","key":"e_1_2_6_2_1","first-page":"423","article-title":"The economic impact of geriatric hip fractures","volume":"28","author":"Youm T","year":"1999","journal-title":"Am J Orthop."},{"key":"e_1_2_6_3_1","doi-asserted-by":"crossref","unstructured":"CummingsSR RubinSM BlackD.The future of hip fractures in the United States: numbers costs and potential effects of post\u2010menopausal estrogen.Clin Orthop Relat Res.1990;(252):163\u2013166.","DOI":"10.1097\/00003086-199003000-00024"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001306"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.171512"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.17606"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B9.BJJ-2017-0101.R1"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-014-1959-y"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000221"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000444"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.08.011"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwq433"},{"key":"e_1_2_6_13_1","unstructured":"WaseyJO.icd: Tools for working with ICD\u20109 and ICD\u201010 codes and finding comorbidities.R package version 3.2.0.https:\/\/CRAN.R\u2010project.org\/package=icd. 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