HIP FRACTURE SURGERY IN NOVA-SCOTIA - A COMPARISON OF TREATMENT PROVIDED BY GENERALIST GENERAL SURGEONS AND ORTHOPEDIC SURGEONS

OBJECTIVE: To determine quality of hip fracture services provided by ' 'generalist'' general surgeons (generalists) in Nova Scotia. DESIGN: C hart review and postoperative, blinded, random-ordered radiologic anal ysis. SETTING: Three community hospitals and 1 tertiary care hospital in Nova Scotia. PARTICIPANTS: Seven generalists who performed 120 hip fracture repairs and 7 orthopedic surgeons (specialists) who performed 135 hip fracture repairs. OUTCOME MEASURES: Patient demographics, pre operative, perioperative, postoperative and discharge information, tec hnical quality of reduction as determined through postoperative radiol ogic assessment. RESULTS: There were no differences between patients t reated by generalists and those treated by specialists with respect to age, sex, American Society of Anesthesiologists' class, level of func tion and fracture type. Intraoperatively, the patient groups were simi lar with respect to type of anesthesia, use of antibiotics, number of transfusions and surgical complications. Significant differences were noted in length of operation (54.4 v. 41.1 minutes), use of C-arm imag ing (6.7% v. 85.9%) and management of Garden classes 1 and 2 subcapita l fractures. Postoperatively, the 2 groups had similar numbers of medi cal complications, wound complications, reoperations, readmissions and deaths, and a similar level of function on discharge. Significant dif ferences included the number of intensive care unit admissions (5.8% v . 15.6%) and length of stay there (5.7 v. 2.8 days) and of postoperati ve stay (14.5 v. 10.7 days). The assessment of radiographs did not dem onstrate any significant difference in the quality of reduction. CONCL USION: In Nova Scotia the outcomes of hip fracture surgery performed b y generalists are comparable to those performed by specialists.