Department of Orthopaedic Surgery, Singapore General Hospital, Outram, Rd, Singapore.
Duke-NUS Medical School, 8 College Rd, Singapore, Singapore.
Arch Osteoporos. 2021 Oct 31;16(1):162. doi: 10.1007/s11657-021-01027-z.
Time to surgery, early mobilization, fracture type, and ASA grades independently affect acute hospital length of stay after hip fracture surgery. Modifiable factors can be audited to reduce length of stay, and non-modifiable factors can be used for consideration of a tiered bundled payment reimbursement model.
As hip fracture incidence rises with our ageing global population, there will be an increase in consumption of healthcare resources. We hypothesized that hospital management and patient factors can affect healthcare burden load. Using length of stay (LOS) as a surrogate for consumption, the aim of this study is to elucidate the effect of hospital management and patient-related factors on length of stay (LOS) for patients after hip fracture surgery. We studied modifiable and non-modifiable factors influencing LOS, and identification of these modifiable factors accords opportunities for mitigating these factors.
This retrospective study examines hip fracture data from a large tertiary hospital in Singapore over the period of 2017 to 2020. Data collected on the electronic medical record included age, gender, race, marital status, payer type, ASA score, TTS, type of surgery, fracture type, POD1 mobilization, discharge position, and presence of pressure sores, and they were correlated with LOS using binary logistic regression on SAS.
A total of 1045 patients were included in this study with 704 females and 341 males. The mean age was 79.5 ± 8.57 years (range 60-105) with an average LOS 13.64 ± 10.0 days (range 2-114). On binary logistic regression, ASA and trochanteric fracture remains a significant non-modifiable factor for LOS with OR = 1.486 (95% CI 1.106, 1.996, p = 0.0086) and OR 1.522 (95% CI 1.149, 2.015, p = 0.0034) respectively. Significant modifiable factors were TTS > 48 h (OR = 1.819, 95% CI 1.205, 2.746, p = 0.0044) and POD1 mobilization (OR = 0.441, 95% CI 0.257, 0.756, p = 0.0029).
Our analysis showed TTS and POD1 are significant modifiable factors for LOS, and resources can be diverted towards them for the management of hip fracture patients and pre-empting the increasing load on our healthcare system.
探讨手术时间、早期活动、骨折类型和美国麻醉医师协会（ASA）分级等因素对髋部骨折手术后患者急性住院时间的影响。可改变的因素可以进行审核以减少住院时间，不可改变的因素可以用于考虑分层捆绑支付报销模式。
本回顾性研究分析了 2017 年至 2020 年期间新加坡一家大型三级医院的髋部骨折数据。电子病历中收集的数据包括年龄、性别、种族、婚姻状况、支付类型、ASA 评分、手术时间（TTS）、手术类型、骨折类型、术后第 1 天（POD1）活动情况、出院位置以及是否存在压疮。使用 SAS 进行二元逻辑回归分析，将这些因素与住院时间相关联。
本研究共纳入 1045 例患者，其中女性 704 例，男性 341 例。患者平均年龄为 79.5±8.57 岁（60-105 岁），平均住院时间为 13.64±10.0 天（2-114 天）。二元逻辑回归分析显示，ASA 和转子间骨折仍然是 LOS 的非可改变的显著因素，OR 值分别为 1.486（95%CI 1.106, 1.996，p=0.0086）和 1.522（95%CI 1.149, 2.015，p=0.0034）。可改变的显著因素为 TTS>48 小时（OR=1.819，95%CI 1.205, 2.746，p=0.0044）和 POD1 活动（OR=0.441，95%CI 0.257, 0.756，p=0.0029）。
我们的分析表明 TTS 和 POD1 是 LOS 的显著可改变因素，可将资源投入到髋部骨折患者的管理中，以应对我们医疗系统不断增加的负担。
