Internal Medicine-Led Multidisciplinary Co-Management is Associated with Improved Perioperative Outcomes in Elderly Patients with Hip Fracture: A Propensity Score Matched Study

Background: Hip fractures in the elderly are associated with substantial morbidity and mortality. We compared perioperative outcomes between an internal medicine-led multidisciplinary co-management (IM) model and the traditional orthopedic-led consultation (OC) model in elderly hip fracture patients. Methods: This retrospective cohort study was conducted at Beijing Jishuitan Hospital Guizhou Hospital from March 2023 to June 2025, enrolling 1095 patients aged ≥ 65 years with hip fractures (IM, n=872; OC, n=223). Propensity score matching (2:1 optimal maximum matching; caliper 0.45 on the logit of the propensity score) balanced 13 covariates, with exact matching for sex, fracture type, and renal insufficiency. Multivariate regression evaluated associations between the care model and perioperative outcomes. Results: After matching, all 223 OC patients were successfully matched (final cohort 668: 445 IM, 223 OC), with all covariates achieving SMD < 0.1 (maximum 0.078). The IM group showed shorter hospital stay (10.0 vs 14.3 days), shorter time to surgery (42.3 vs 110.1 hours), less blood loss, and lower costs (all p < 0.001). Surgery within 48 hours was more frequent (70.3% vs 8.5%, p < 0.001), and allogeneic transfusion (49.4% vs 68.2%, p < 0.001) and one-year mortality (7.0% vs 12.6%, p = 0.016) were lower in the IM group. Multivariate analysis confirmed an independent association with lower mortality (OR 0.492, 95% CI 0.280– 0.863, p = 0.013). Conclusion: Internal medicine-led multidisciplinary co-management may be associated with shorter preoperative waiting time and hospital stay, reduced blood loss, allogeneic transfusion, one-year mortality, and medical costs. This model may serve as a reference strategy for perioperative management of geriatric hip fracture where multidisciplinary internal medicine resources are available; multicenter prospective studies are warranted. Keywords: geriatric hip fracture, internal medicine-led, multidisciplinary team, propensity score matching, mortality