From the Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL.
J Am Acad Orthop Surg Glob Res Rev. 2021 May 4;5(5):e21.00073. doi: 10.5435/JAAOSGlobal-D-21-00073.
Within the geriatric hip fracture population, there exists a subset of patients whose length of inpatient hospital stay is excessive relative to the average. A better understanding of the risk factors associated with this group would be of value so that targeted prevention efforts can be properly directed. The goal of this study was to identify and characterize the risk factors associated with an extended length of hospital stay (eLOS) in the geriatric hip fracture population. In addition, a statistical model was created to predict the probability of eLOS in a geriatric hip fracture patient.
The National Surgical Quality Improvement Program database (2005 to 2018) was searched for patients aged ≥65 years who underwent hip fracture surgery. Patients with a hospital stay greater than or equal to 14 days were considered to have an eLOS. A multivariate logistic regression model using 24 patient characteristics from two-thirds of the study population was created to determine independent risk factors predictive of having an eLOS; the remaining one-third of the population was used for internal model validation. Regression analyses were performed to determine preoperative and postoperative risk factors for having an eLOS.
A total of 77,144 patients were included in the study. Preoperatively, male sex, dyspnea, ventilator use, chronic obstructive pulmonary disease, American Society of Anesthesiologist class 3 and 4, and increased admission-to-operation time were among the factors associated with higher odds of having an eLOS (all P < 0.001). Postoperatively, patients with acute renal failure had the highest likelihood of eLOS (odds ratio [OR] 7.664), followed by ventilator use >48 hours (OR 4.784) and pneumonia (OR 4.332).
Among geriatric hip fracture patients, particular efforts should be directed toward optimizing those with preoperative risk factors for eLOS. Preemptive measures to target the postoperative complications with the strongest eLOS association may be beneficial for both the patient and the healthcare system as a whole.
在老年髋部骨折患者中，存在一部分患者的住院时间明显长于平均水平。更好地了解与该群体相关的风险因素将具有重要价值，以便能够有针对性地进行预防。本研究的目的是确定并描述与老年髋部骨折患者住院时间延长（eLOS）相关的风险因素。此外，还创建了一个统计模型，以预测老年髋部骨折患者发生 eLOS 的概率。
在国家手术质量改进计划数据库（2005 年至 2018 年）中搜索了年龄≥65 岁接受髋部骨折手术的患者。住院时间超过或等于 14 天的患者被认为存在 eLOS。使用研究人群的三分之二患者的 24 项患者特征创建了一个多变量逻辑回归模型，以确定具有 eLOS 的独立预测风险因素；其余三分之一的人群用于内部模型验证。进行回归分析以确定术前和术后发生 eLOS 的风险因素。
共有 77144 例患者纳入研究。术前，男性、呼吸困难、使用呼吸机、慢性阻塞性肺疾病、美国麻醉师协会 3 级和 4 级以及入院至手术时间增加均与更高的 eLOS 发生几率相关（均 P <0.001）。术后，急性肾衰竭患者发生 eLOS 的可能性最大（比值比[OR]7.664），其次是使用呼吸机>48 小时（OR 4.784）和肺炎（OR 4.332）。
在老年髋部骨折患者中，应特别注意针对 eLOS 的术前风险因素进行优化。针对与 eLOS 关联最强的术后并发症采取先发制人的措施可能对患者和整个医疗保健系统都有益。
