Osteoporotic hip fractures are a major health problems in geriatric patients. Some complications are specific to elderly patients after surgery, and lead to geriatric syndromes that are associated with poor survival. The involvement of geriatricians may improve the care of older, patients with complex hip fractures. In 1990, approximately 1.3 million hip fractures were diagnosed worldwide [1]. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospitals after hip fractures. The term “orthogeriatric” refers to collaboration between orthopedic surgeons and geriatricians to improve outcomes of patients with hip fracture [2].

Such collaboration is of clinical importance in Japan because of the increasing number of elderly patients with hip fractures under the rapid expansion of the elderly population.

Presently, orthopedic surgeons examine internal medicine diseases and conduct medical examinations each time during the perioperative period of femoral surgery in Japan. The perioperative surgical complications include pneumonia, urinary retention, venous thrombosis of the lower extremities, delirium, and heart failure. Moreover, pneumonitis, urinary retention, urinary tract infection, and lower extremity venous thrombosis have been reported in 4.5%, 40%, 24%, and 8.6% of cases, respectively [3]. The 30-day and 1-year mortality rates have been reported to be 9.6% and 33%, respectively, the pneumonitis admission rate was 9%, heart failure rate was 5% [4]. In our previous studies, the incidence of pneumonia and urinary retention were 4.23% and 15.4%, respectively [5,6].

In a previous study, a “multidisciplinary care model”, was introduced as a new model of care that provides active treatment via collaboration among orthopedic surgery, internal medicine, and all other disciplines involved in hip fracture treatment [7].

The incidence of postoperative pneumonia and urinary tract infection in the perioperative period was lowered by the intervention of geriatricians, and the mortality rate decreased after one year [8,9]; however, reports from Japan are limited. Shigemoto et al. reported a reduction in the length of hospital stay and hospital costs, and improved activities of daily living (ADL) at discharge [10]. After consulting a specialist department, diseases that do not meet the consultation criteria can be detected by an internist. Since April 2017, a specialist in geriatrics has been assigned to the ward because it is necessary to provide an overview of the patient's whole body. Multiple internal use countermeasures for drugs are being cooperatively conducted by doctors, pharmacists, and nurses. Consultations with specialist departments are useful for organ-specific examinations, but it is difficult to perform a comprehensive examination to evaluate the general condition from the time of admission to the time of discharge. A retrospective study based on the data of actual conditions in home healthcare settings in Japan reported potentially inappropriate prescriptions in 48.4% and inappropriate prescriptions in 8.0% of them [11]. One in five patients in the primary care domain received inappropriate medication [12]. Few studies have examined the oral medication status of hip fracture patients in Japan. Medications for elderly patients with hip fractures have also been analyzed, and polypharmacy has been found to be responsible for falls, resulting in fractures [13]. Antihypertensive drugs, sleep medication and loop diuretics were also found to be responsible for falls. Furthermore, the use of multiple medications is an established risk factor for falls [[14], [15], [16], [17], [18]].

To the best of our knowledge, this is the first study in Japan, which aimed to report the significance of in-patient intervention by elderly physicians, in addition to conventional multi-professional collaboration. Furthermore, we determined predictors of urinary retention and pneumonia, and discussed the significance of geatricians' interventions.