Osteoporosis International

, Volume 30, Issue 1, pp 145–153 | Cite as

Length of hospital stay after hip fracture surgery and 1-year mortality

  • J. Yoo
  • J.S. Lee
  • S. Kim
  • B.S. Kim
  • H. Choi
  • D.Y. Song
  • W.B. Kim
  • C.W. WonEmail author
Original Article



There is ongoing effort to discharge patients early after hip fracture surgery to reduce the medical and economic burden. We tried to find whether there is any related side effect, and discovered that early discharge, especially before 10 days after surgery, is associated with higher mortality.


The aim of this study was to analyze the association between the length of hospital stay after hip fracture and 1-year mortality in older adults aged ≥ 65 years old.


We conducted a retrospective cohort study using the Korean National Health Insurance Service data to identify patients who were discharged after hip fracture surgery from 2007 to 2009 among 487,460 older adults of age ≥ 65 years. The lengths of stay involving hip fracture surgery were categorized at 10-day interval, and analyzed in relation to 1-year mortality from the date of hospital discharge.


A total of 4213 patients were discharged after hip fracture surgery, of whom 604 (14.3%) died within 1 year of discharge. The average length of stay was 30.7 days (standard deviation 24.5 days). The 1-year mortality was the highest for the length of stay ≤ 10 days group at 21.7%, followed by 15.2%, 14.3%, 13.3%, and 12.4% for > 40, 21–30, 31–40, and 11–20 days groups, respectively (p value 0.05). On Cox proportional hazard regression, the adjusted hazard ratio for length of stay ≤ 10 days group was 1.56 (95% confidence interval 1.14–2.12) against the reference group (11–20 days), while other groups did not show statistical significance. Higher risk of death was associated with increasing age, male gender, Charlson comorbidity index ≥3, subtrochanteric fracture, and discharge to tertiary care hospitals and long-term care hospitals.


Older adults discharged within 10 days of hospital admission for hip fracture surgery have higher 1-year mortality after discharge.


Frail elderly Healthcare administrative claims Hip fractures Mortality 


Compliance with ethical standards

This study was approved by the Kyung Hee University Hospital Research Ethics Committee (Approval ID: KHUH 2017-01-069).

Conflicts of interest

This study used NHIS-Senior data (NHIS-2017-2-328) made by NHIS. Jinho Yoo, Ji Sung Lee, Sunyoung Kim, Byung Sung Kim, Hyunrim Choi, Da Young Song, Won Beom Kim, and Chang Won Won declare no conflict of interest with NHIS.

Supplementary material

198_2018_4747_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21 kb)


  1. 1.
    Nazrun AS, Tzar MN, Mokhtar SA, Mohamed IN (2014) A systematic review of the outcomes of osteoporotic fracture patients after hospital discharge: morbidity, subsequent fractures, and mortality. Ther Clin Risk Manag 10:937–948Google Scholar
  2. 2.
    Kanis J, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby A (2003) The components of excess mortality after hip fracture. Bone 32(5):468–473CrossRefGoogle Scholar
  3. 3.
    Abrahamsen B, Van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20(10):1633–1650CrossRefGoogle Scholar
  4. 4.
    Forsén L, Søgaard A, Meyer H, Edna T-H, Kopjar B (1999) Survival after hip fracture: short-and long-term excess mortality according to age and gender. Osteoporos Int 10(1):73–78CrossRefGoogle Scholar
  5. 5.
    Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR (1997) Excess mortality attributable to hip fracture in white women aged 70 years and older. Am J Public Health 87(10):1630–1636CrossRefGoogle Scholar
  6. 6.
    Schrøder HM, Erlandsen M (1993) Age and sex as determinants of mortality after hip fracture: 3,895 patients followed for 2.5-18.5 years. J Orthop Trauma 7(6):525–531CrossRefGoogle Scholar
  7. 7.
    Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD (1995) Ambulatory ability after hip fracture: a prospective study in geriatric patients. Clin Orthop Relat Res (310):150–159Google Scholar
  8. 8.
    Kitamura S, Hasegawa Y, Suzuki S, Sasaki R, Iwata H, Wingstrand H, Thorngren K-G (1998) Functional outcome after hip fracture in Japan. Clin Orthop Relat Res 348:29-36CrossRefGoogle Scholar
  9. 9.
    Van Balen R, Steyerberg E, Polder J, Ribbers T, Habbema J, Cools H (2001) Hip fracture in elderly patients: outcomes for function, quality of life, and type of residence. Clin Orthop Relat Res 390:232–243CrossRefGoogle Scholar
  10. 10.
    Fisher A, Martin J, Srikusalanukul W, Davis M (2010) Bisphosphonate use and hip fracture epidemiology: ecologic proof from the contrary. Clin Interv Aging 5:355–362CrossRefGoogle Scholar
  11. 11.
    Dhanwal DK, Dennison EM, Harvey NC, Cooper C (2011) Epidemiology of hip fracture: worldwide geographic variation. Indian journal of orthopaedics 45(1):15–22. CrossRefGoogle Scholar
  12. 12.
    He W, Goodkind D, Kowal PR (2016) An aging world: 2015. United States Census BureauGoogle Scholar
  13. 13.
    Bergen G (2016) Falls and fall injuries among adults aged≥ 65 years—United States, 2014. Morb Mortal Wkly Rep 65(37):993–998CrossRefGoogle Scholar
  14. 14.
    Milat AJ, Watson WL, Monger C, Barr M, Giffin M, Reid M (2011) Prevalence, circumstances and consequences of falls among community-dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey. New South Wales public health bulletin 22(4):43–48CrossRefGoogle Scholar
  15. 15.
    Rubenstein LZ, Josephson KR (2002) The epidemiology of falls and syncope. Clin Geriatr Med 18(2):141–158CrossRefGoogle Scholar
  16. 16.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475CrossRefGoogle Scholar
  17. 17.
    Burgers PT, Van Lieshout EM, Verhelst J, Dawson I, de Rijcke PA (2014) Implementing a clinical pathway for hip fractures; effects on hospital length of stay and complication rates in five hundred and twenty six patients. Int Orthop 38(5):1045–1050Google Scholar
  18. 18.
    Lau T-W, Fang C, Leung F (2013) The effectiveness of a geriatric hip fracture clinical pathway in reducing hospital and rehabilitation length of stay and improving short-term mortality rates. Geriatric orthopaedic surgery & rehabilitation 4(1):3–9. CrossRefGoogle Scholar
  19. 19.
    Lee J, Lee JS, Park S-H, Shin SA, Kim K (2016) Cohort profile: the national health insurance service–national sample cohort (NHIS-NSC), South Korea. Int J Epidemiol:dyv319Google Scholar
  20. 20.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefGoogle Scholar
  21. 21.
    Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43(11):1130–1139CrossRefGoogle Scholar
  22. 22.
    Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL (2002) Medical complications and outcomes after hip fracture repair. Arch Intern Med 162(18):2053–2057CrossRefGoogle Scholar
  23. 23.
    Nikkel LE, Kates SL, Schreck M, Maceroli M, Mahmood B, Elfar JC (2015) Length of hospital stay after hip fracture and risk of early mortality after discharge in New York state: retrospective cohort study. BMJ (Clinical research ed) 351:h6246Google Scholar
  24. 24.
    Nordström P, Gustafson Y, Michaëlsson K, Nordström A (2015) Length of hospital stay after hip fracture and short term risk of death after discharge: a total cohort study in Sweden. BMJ Br Med J 350Google Scholar
  25. 25.
    Ireland AW, Kelly PJ, Cumming RG (2015) Total hospital stay for hip fracture: measuring the variations due to pre-fracture residence, rehabilitation, complications and comorbidities. BMC Health Serv Res 15(1):17CrossRefGoogle Scholar
  26. 26.
    Leal J, Gray AM, Prieto-Alhambra D, Arden NK, Cooper C, Javaid MK, Judge A (2016) Impact of hip fracture on hospital care costs: a population-based study. Osteoporos Int 27(2):549–558. CrossRefGoogle Scholar
  27. 27.
    Sakuma M, Endo N, Oinuma T, Endo E, Yazawa T, Watanabe K, Watanabe S (2008) Incidence and outcome of osteoporotic fractures in 2004 in Sado City, Niigata Prefecture, Japan. J Bone Miner Metab 26(4):373–378. CrossRefGoogle Scholar
  28. 28.
    Sund R, Juntunen M, Lüthje P, Huusko T, Häkkinen U (2011) Monitoring the performance of hip fracture treatment in Finland. Ann Med 43(sup1):S39–S46CrossRefGoogle Scholar
  29. 29.
    Hommel A, Ulander K, Bjorkelund KB, Norrman P-O, Wingstrand H, Thorngren K-G (2008) Influence of optimised treatment of people with hip fracture on time to operation, length of hospital stay, reoperations and mortality within 1 year. Injury 39(10):1164–1174CrossRefGoogle Scholar
  30. 30.
    Bentler S, Liu L, Obrizan M, Cook E, Wright K, Geweke J, Chrischilles E, Pavlik C, Wallace R, Ohsfeldt R (2009) The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 170(10):1290–1299CrossRefGoogle Scholar
  31. 31.
    Nordström P, Michaëlsson K, Hommel A, Norrman PO, Thorngren K-G, Nordström A (2016) Geriatric rehabilitation and discharge location after hip fracture in relation to the risks of death and readmission. J Am Med Dir Assoc 17(1):91.e91–91.e97. CrossRefGoogle Scholar
  32. 32.
    Shin SS, Eu Y (2015) Relationships among pain, depression, health behavior, and activities of daily living in older adults after femur fracture surgery. J Muscle Jt Health 22(1):1–12CrossRefGoogle Scholar
  33. 33.
    Johansen A, Wakeman R, Boulton C, Plant F, Roberts J, Williams A (2013) National Hip Fracture Database: national report 2013. London: Royal College of PhysiciansGoogle Scholar
  34. 34.
    Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ (Clinical research ed) 331(7529):1374. CrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2018

Authors and Affiliations

  • J. Yoo
    • 1
  • J.S. Lee
    • 2
  • S. Kim
    • 1
  • B.S. Kim
    • 1
  • H. Choi
    • 1
  • D.Y. Song
    • 3
  • W.B. Kim
    • 4
  • C.W. Won
    • 1
    Email author
  1. 1.Department of Family Medicine, College of MedicineKyung Hee UniversitySeoulSouth Korea
  2. 2.Clinical Research Center, Asan Medical CenterSeoulSouth Korea
  3. 3.Elderly Frailty Research CenterKyung Hee UniversitySeoulSouth Korea
  4. 4.Department of Medicine, Graduate SchoolKyung Hee UniversitySeoulSouth Korea

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