Effect of orthopaedic–internal medicine co-management on 1-year mortality in older patients with hip fractures: a retrospective real-world study

When an older adult breaks a hip, the injury is more than just a broken bone; it is a sudden, severe test of the body's entire system. The fracture itself is painful and immobilizing, but the real danger often lies in what happens while the patient waits for treatment. During those waiting hours, the body begins to weaken. Muscles atrophy, the lungs become prone to infection, and existing health conditions like heart disease or diabetes can spiral out of control. Medical guidelines have long suggested that surgery should happen quickly, ideally within two days of admission, to prevent these complications. However, in many hospitals, getting a patient from the emergency room to the operating table takes far longer due to a fragmented system where different specialists work in isolation, creating bottlenecks that delay life-saving care.

A team of researchers at Mianyang Orthopaedic Hospital in China set out to see if changing how these patients are managed could save lives. They focused on a specific approach called co-management, where an internal medicine doctor works side-by-side with the orthopaedic surgeon from the moment the patient arrives. Instead of the surgeon waiting for a separate medical team to clear the patient for surgery, the two specialists collaborate immediately, running tests and managing health issues in parallel. The researchers wanted to know if this teamwork could shorten the wait for surgery and, more importantly, reduce the number of deaths among elderly patients over the following year.

The study looked at 882 older patients, all aged 65 or older, who had suffered a fresh hip fracture and were treated surgically over a two-year period. The researchers divided these patients into two groups based on when they were treated. The first group, consisting of 407 patients, received the standard care that was in place before the new system was introduced. In this conventional setup, the patient would be admitted, and various departments would be consulted one after another, often leading to significant delays. The second group, comprising 475 patients, was treated after the hospital implemented the co-management model. In this new system, an internal medicine specialist was embedded directly within the joint surgery unit. As soon as a patient arrived, this specialist and the surgeon worked together to prioritize admission, order necessary tests simultaneously, and clear the patient for anesthesia without the usual bureaucratic waiting.

The results showed a stark difference between the two approaches. In the group receiving standard care, the average time from admission to surgery was 92 hours, or nearly four days. Only 13 percent of these patients were operated on within the recommended 48-hour window. In contrast, the co-management group saw their average wait time drop to just 28 hours, and a remarkable 83 percent of them underwent surgery within 48 hours. This speed was not just a matter of efficiency; it translated directly into better survival rates. One year after the injury, 14 percent of the patients in the standard care group had died, compared to only 8.2 percent in the co-management group. The difference was even more pronounced at the 90-day mark, where mortality dropped from 6.1 percent to 2.9 percent.

Beyond saving lives, the co-management model improved the overall quality of the hospital stay. Patients in the new system spent less time in the hospital, with an average stay of 12 days compared to 15 days for the standard group. They also required fewer blood transfusions and experienced fewer lung infections, a common and dangerous complication for bedridden elderly patients. The total cost of hospitalization was also lower for the co-management group, dropping by roughly 1,600 Chinese yuan per patient. The researchers found that the speed of surgery was a critical factor; every hour the surgery was delayed was associated with a slightly higher risk of death within the year. However, even after accounting for the time to surgery, the co-management model itself remained a strong protective factor, suggesting that the benefits came not just from moving faster, but from the continuous, coordinated medical attention the patients received.

The study also identified specific factors that made some patients more vulnerable than others. Older age and a history of Parkinson's disease were linked to a higher risk of death, while higher levels of albumin, a protein that indicates good nutritional status, were linked to better survival. The researchers noted that patients with Parkinson's disease faced unique challenges, such as difficulty swallowing and a higher risk of aspiration, which required careful management regardless of how quickly surgery occurred. While the co-management model successfully shortened wait times and reduced deaths, it could not completely eliminate the inherent risks associated with these complex underlying conditions.

This research provides strong evidence that integrating medical and surgical care can fundamentally change outcomes for vulnerable patients. By breaking down the barriers between departments and ensuring that a medical specialist is involved from the very first moment, hospitals can move patients through the system more safely and efficiently. The findings suggest that in settings where delays are common, simply organizing the team to work together in real-time is a powerful tool for saving lives, reducing complications, and lowering costs. The study acknowledges that it was conducted at a single hospital and relied on comparing patients before and after a policy change, so further research is needed to confirm these results in other locations. Nevertheless, the data clearly shows that when doctors work as a unified team rather than in separate silos, the result is a shorter wait, a safer recovery, and a significantly higher chance of survival for older adults facing a hip fracture.