Predictive Scoring Methods for Postoperative Level of Care Needs in the Geriatric Hip Fracture Patient Population.

Introduction: This study's purpose was to use a postoperative ICU geriatric prediction score (PIGS) to determine the appropriateness of postoperative ICU/SDU admission or unnecessary use of advanced care services in geriatric femur fracture patients at our Level III trauma center. Methods: This is a retrospective review of 142 patients, age 65 years or older, at a level III trauma center from 3/2021-9/2022 that required surgical fixation of a femur fracture. Collected data included demographics, injury characteristics, postoperative complications, hospital charges, and admission to ICU or SDU. Results: Average age was 81.5 years. 32% of patients were male and 40% were femoral neck fractures. The average PIGS score was 7.1. 17% of patients admitted to the SDU met the PIGS threshold for ICU transfer. 7% were transferred to the ICU after being admitted to the SDU postoperatively, 0% of whom met criteria for ICU admission at the level 1 trauma center. Predictive factors for their transfer to the ICU at the level 3 trauma center was postoperative blood transfusion (OR:4.11;CI 1.09,15.45; Conclusion: The geriatric population with a femur fracture is often unnecessarily admitted to advanced care units postoperatively. The PIGS system has been validated for use in a level 1 trauma center in the geriatric population undergoing hip fracture surgery. Here, we validate its use in the geriatric population undergoing femur fracture surgery at a level III trauma center, where majority of patients may not meet the criteria for advanced care and could be cared for more cost-effectively.