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When does hip fracture surgery delay affects the length of hospital stay?

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To define factors influencing length of hospital stay (LOS) besides surgery delay.

Methods

We retrospectively analyzed 634 patients operated for hip fractures in 1-year period. Investigated characteristics were age, gender, American Society of Anesthesiologists score (ASA), time to surgery (first 48 h was considered early), type of surgery, anticoagulant therapy and non-routine pre-operative tests. Univariate and multivariable analysis were performed. p values < 0.05 were considered statistically significant.

Results

Median LOS was 12 days. Patients operated within 48 h had a LOS of 10 days, while patients operated after 48 h had 4 days longer LOS (p < 0.01). In multiple regression analyses, it was predicted that patients operated after 48 h with every 10 h delay to surgery had 7.3 h longer hospitalizations. All other factors did not influence the LOS. In early operation group, patients with hip arthroplasty had 3.3 days longer hospitalization compared to patients with osteosynthesis, every higher ASA score was associated with 1.4 days longer hospitalization, patients on anticoagulant therapy had 2.6 days longer LOS but surgery delay had no influence on LOS. Preinjury residence at a nursing home was associated with 4.4 days shorter hospitalizations compared to preinjury residence at home in both time frames.

Conclusions

In patients operated in first 48 h longer LOS is associated with ASA, anticoagulant therapy and operation type but not with delay to surgery. If patients are operated after 48 h, surgery delay is the only factor increasing LOS.

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Data availability

The analyzed data are available by the authors.

References

  1. Lewis PM, Waddell JP. When is the ideal time to operate on a patient with a fracture of the hip? A review of the available literature. Bone Joint J. 2016;98-B(12):1573–81.

    Article  CAS  Google Scholar 

  2. Ftouh S, Morga A, Swift C, Guideline Development Group. Management of hip fracture in adults: summary of NICE guidance. BMJ. 2011;342:d3304.

    Article  Google Scholar 

  3. Guy P, Sheehan KJ, Morin SN, Waddell J, Dunbar M, Harvey E, Sirett S, Sobolev B, Kuramoto L, Tang M, Canadian Collaborative Study on Hip Fractures. Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery: a Canadian database study. BMJ Open. 2017;7(10):e017869.

    Article  Google Scholar 

  4. Müller-Mai CM, Schulze Raestrup US, Kostuj T, Dahlhoff G, Günster C, Smektala R. One-year outcomes for proximal femoral fractures: posthospital analysis of mortality and care levels based on health insurance data. Unfallchirurg. 2015;118(9):780–94.

    Article  Google Scholar 

  5. Heyes GJ, Tucker A, Marley D, Foster A. Predictors for 1-year mortality following hip fracture: a retrospective review of 465 consecutive patients. Eur J Trauma Emerg Surg. 2017;43(1):113–9.

    Article  CAS  Google Scholar 

  6. Pincus D, Ravi B, Wasserstein D, Huang A, Paterson JM, Nathens AB, Kreder HJ, Jenkinson RJ, Wodchis WP. Association between wait time and 30-day mortality in adults undergoing hip fracture surgery. JAMA. 2017;318(20):1994–2003.

    Article  Google Scholar 

  7. Simunovic N, Devereaux PJ, Sprague S, Guyatt GH, Schemitsch E, Debeer J, Bhandari M. Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ. 2010;182(15):1609–16.

    Article  Google Scholar 

  8. Al-Ani AN, Samuelsson B, Tidermark J, Norling A. Early operation on patients with a hip fracture improved the ability to return to independent living. A prospective study of 850 patients. J Bone Joint Surg Am. 2008;90(7):1436–42.

    Article  Google Scholar 

  9. Mitchell SM, Chung AS, Walker JB, Hustedt JW, Russell GV, Jones CB. Delay in hip fracture surgery prolongs postoperative hospital length of stay but does not adversely affect outcomes at 30 days. J Orthop Trauma. 2018;32(12).

  10. Sermon A, Rochus I, Smeets B, Metsemakers WJ, Misselyn D, Nijs S, Hoekstra H. The implementation of a clinical pathway enhancing early surgery for geriatric hip fractures: how to maintain a success story? Eur J Trauma Emerg Surg. 2019;45(2):199–205.

    Article  Google Scholar 

  11. Siegmeth AW, Gurusamy K, Parker MJ. Delay to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br. 2005;87(8):1123–6.

    Article  CAS  Google Scholar 

  12. Rosman M, Rachminov O, Segal O, Segal G. Prolonged patients’ in-hospital waiting period after discharge eligibility is associated with increased risk of infection, morbidity and mortality: a retrospective cohort analysis. BMC Health Serv Res. 2015;25(15):246.

    Article  Google Scholar 

  13. Yoo J, Lee JS, Kim S, Kim BS, Choi H, Song DY, Kim WB, Won CW. Length of hospital stay after hip fracture surgery and 1-year mortality. Osteoporos Int. 2019;30(1):145–53.

    Article  CAS  Google Scholar 

  14. Kristan A, Omehen S, Cimerman M. Causes for delay tu surgery in hip fractures and how it impacts on mortality—a single level 1 trauma center experience. ACHOT; 1/2021 (in press)

  15. Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med. 2017;377(21):2053–62.

    Article  Google Scholar 

  16. Lefaivre KA, Macadam SA, Davidson DJ, Gandhi R, Chan H, Broekhuyse HM. Length of stay, mortality, morbidity and delay to surgery in hip fractures. J Bone Joint Surg Br. 2009;91(7):922–7.

    Article  CAS  Google Scholar 

  17. Basques BA, Bohl DD, Golinvaux NS, Leslie MP, Baumgaertner MR, Grauer JN. Postoperative length of stay and 30-day readmission after geriatric hip fracture: an analysis of 8434 patients. J Orthop Trauma. 2015;29(3):e115–20.

    Article  Google Scholar 

  18. Castelli A, Daidone S, Jacobs R, Kasteridis P, Street AD. The determinants of costs and length of stay for hip fracture patients. PLoS ONE. 2015;10(7):e0133545.

    Article  Google Scholar 

  19. Richards T, Glendenning A, Benson D, Alexander S, Thati S. The independent patient factors that affect length of stay following hip fractures. Ann R Coll Surg Engl. 2018;100(7):556–62.

    Article  CAS  Google Scholar 

  20. Lawrence JE, Fountain DM, Cundall-Curry DJ, Carrothers AD. Do patients taking warfarin experience delays to theatre, longer hospital stay, and poorer survival after hip fracture. Clin Orthop Relat Res. 2017;475(1):273–9.

    Article  Google Scholar 

  21. Bernstein J, Roberts FO, Wiesel BB, Ahn J. Preoperative testing for hip fracture patients delays surgery, prolongs hospital stays, and rarely dictates care. J Orthop Trauma. 2016;30(2):78–80.

    Article  Google Scholar 

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Funding

The research was not funded.

Author information

Authors and Affiliations

  1. Department of Traumatology, University Medical Center Ljubljana, 1000, Ljubljana, Slovenia

    Anže Kristan, Sabastjan Omahen & Matej Cimerman

  2. Medical School, University of Crete, 71003, Heraklion, Greece

    Theodoros Hercules Tosounidis

Authors
  1. Anže Kristan
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  2. Sabastjan Omahen
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  3. Theodoros Hercules Tosounidis
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  4. Matej Cimerman
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All above-mentioned authors agree with submitting this article for publication.

Corresponding author

Correspondence to Anže Kristan.

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Conflict of interest

None of the authors have conflict of interest regarding the study.

Ethical standards

The study was conducted in compliance with national legislation and approved by the National Medical Ethics Committee of Ministry of Health. (Reference no. 0120-358/2018/4).

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Kristan, A., Omahen, S., Tosounidis, T.H. et al. When does hip fracture surgery delay affects the length of hospital stay?. Eur J Trauma Emerg Surg 48, 701–708 (2022). https://doi.org/10.1007/s00068-020-01565-0

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  • DOI: https://doi.org/10.1007/s00068-020-01565-0

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