Skip to main content
Top
Published in: European Journal of Trauma and Emergency Surgery 2/2022

01-04-2022 | Original Article

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

Authors: Anže Kristan, Sabastjan Omahen, Theodoros Hercules Tosounidis, Matej Cimerman

Published in: European Journal of Trauma and Emergency Surgery | Issue 2/2022

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference 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.CrossRef 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.CrossRef
2.
go back to reference Ftouh S, Morga A, Swift C, Guideline Development Group. Management of hip fracture in adults: summary of NICE guidance. BMJ. 2011;342:d3304.CrossRef Ftouh S, Morga A, Swift C, Guideline Development Group. Management of hip fracture in adults: summary of NICE guidance. BMJ. 2011;342:d3304.CrossRef
3.
go back to reference 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.CrossRef 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.CrossRef
4.
go back to reference 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.CrossRef 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.CrossRef
5.
go back to reference 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.CrossRef 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.CrossRef
6.
go back to reference 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.CrossRef 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.CrossRef
7.
go back to reference 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.CrossRef 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.CrossRef
8.
go back to reference 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.CrossRef 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.CrossRef
9.
go back to reference 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). 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.
go back to reference 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.CrossRef 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.CrossRef
11.
go back to reference 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.CrossRef 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.CrossRef
12.
go back to reference 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.CrossRef 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.CrossRef
13.
go back to reference 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.CrossRef 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.CrossRef
14.
go back to reference 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) 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.
go back to reference Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med. 2017;377(21):2053–62.CrossRef Bhandari M, Swiontkowski M. Management of acute hip fracture. N Engl J Med. 2017;377(21):2053–62.CrossRef
16.
go back to reference 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.CrossRef 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.CrossRef
17.
go back to reference 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.CrossRef 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.CrossRef
18.
go back to reference 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.CrossRef 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.CrossRef
19.
go back to reference 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.CrossRef 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.CrossRef
20.
go back to reference 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.CrossRef 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.CrossRef
21.
go back to reference 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.CrossRef 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.CrossRef
Metadata
Title
When does hip fracture surgery delay affects the length of hospital stay?
Authors
Anže Kristan
Sabastjan Omahen
Theodoros Hercules Tosounidis
Matej Cimerman
Publication date
01-04-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 2/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01565-0

Other articles of this Issue 2/2022

European Journal of Trauma and Emergency Surgery 2/2022 Go to the issue