The impact of pre- versus postoperative geriatric consultation in elderly patients with hip fractures.

PURPOSE: To determine whether preoperative geriatric consultation was independently associated with lower incidence of delirium for elderly patients with hip fractures compared with postoperative geriatric consultation.

METHODS

This retrospective cohort study was conducted at two urban Level 1 trauma centers in the United States. Patients aged ≥ 70 years with isolated proximal femur fractures treated surgically between 2018 and 2024 were included. Patients with pathological or periprosthetic fractures, non-orthopedic admissions, and those without geriatric consultation were excluded. Patients were categorized based on timing of initial geriatric consultation: preoperative versus postoperative. Delirium was selected as the primary outcome because geriatric consultation most directly addresses modifiable delirium risk factors. Secondary outcomes included the incidence of one or more in-hospital complications, length of stay, 30-day all-cause readmissions, and mortality. Multivariable logistic and linear regression analyses were used to determine the independent association between timing of initial geriatric consultation and primary and secondary outcomes.

RESULTS

Of 1776 patients included, 1382 (78%) received initial geriatric consultation preoperatively and 394 (22%) postoperatively. Median age was 84 years (IQR 78-90), 70% were female, 73% ASA III, and 87% lived at home pre-admission. Delirium occurred in 19.7% in the preoperative vs. 19.5% in the postoperative groups. After adjustment, consultation timing was not independently associated with delirium (aOR = 1.09, 95%-CI = 0.81-1.47, p=.567).

CONCLUSIONS

Preoperative versus postoperative initial geriatric consultation was not independently associated with delirium incidence and produced comparable short-term clinical outcomes.

LEVEL OF EVIDENCE: Prognostic Level III.