From the Garden City Hospital, Orthopedic Surgery Residency Program, Garden City, MI (Dr. Schweller, Dr. Mueller, and Dr. Walkiewicz); the Graduate Medical Education , Garden City Hospital, Garden City, MI (Dr. Santiago Rivera); and the Michigan State University College of Osteopathic Medicine, East Lansing, MI (Dr. Santiago Rivera and Dr. Villegas).
J Am Acad Orthop Surg Glob Res Rev. 2023 May 2;7(5). doi: 10.5435/JAAOSGlobal-D-22-00195. eCollection 2023 May 1.
Hip fractures in geriatric populations constitute a heavy burden on the healthcare system. The study goal was to identify patient, hospital, and surgical factors associated with hospital length of stay (LOS) for geriatric patients with hip fractures requiring surgical intervention in a community hospital setting.
This was a cross-sectional retrospective chart review of geriatric hip fractures that underwent surgical fixation at a community hospital between 2017 and 2019. The scope of the surgeries was limited to cephalomedullary device fixation or hemiarthroplasty hip fracture surgeries. Sliding hip screw or total hip arthroplasty procedures and patients who died during the index hospitalization were excluded. Median tests were conducted to examine differences between the groups. Unadjusted and adjusted truncated negative binomial regression models were used to examine the factors associated with LOS.
Bivariate analyses revealed results that the factors associated with a longer LOS were preoperative anemia (P = 0.029), blood transfusion (P = 0.022), and the number of days between admission and surgery (P = 0.001). The adjusted regression model results suggested that older patients, patients who underwent surgery more than one day after admission, current smokers, malnourished patients, patients with sepsis, and patients with a history of a thromboembolic event had statistically significant (P < 0.05) longer LOS. However, patients who live in institutions (nursing homes or assisted living) had a shorter LOS than those who live at home alone or with family (P < 0.05).
Older adult patients who underwent surgery with a cephalomedullary device or hip hemiarthroplasty for a hip fracture and had preoperative anemia, postoperative blood transfusions, and increased days between admission and surgery had a longer LOS. Additional factors positively associated with a longer LOS included current smokers, malnourishment, admission with sepsis, and patients with a history of a thromboembolic event. Of interest, institutionalized patients had a shorter LOS than those living at home alone or with family.
老年人髋部骨折给医疗保健系统带来了沉重负担。本研究旨在确定在社区医院环境中接受手术治疗的老年髋部骨折患者的患者、医院和手术相关因素与住院时间（LOS）的关系。
这是一项回顾性横断面研究，研究对象为 2017 年至 2019 年期间在社区医院接受手术固定治疗的老年髋部骨折患者。手术范围仅限于股骨近端髓内装置固定或人工髋关节置换术。排除使用滑动髋螺钉或全髋关节置换术的患者和在指数住院期间死亡的患者。中位数检验用于检验组间差异。使用未调整和调整的截断负二项回归模型来检验 LOS 相关因素。
单变量分析结果表明，与 LOS 较长相关的因素包括术前贫血（P=0.029）、输血（P=0.022）和入院至手术的天数（P=0.001）。调整后的回归模型结果表明，年龄较大的患者、入院后手术时间超过 1 天的患者、当前吸烟者、营养不良的患者、患有脓毒症的患者以及有血栓栓塞事件史的患者的 LOS 明显更长（P<0.05）。然而，住在机构（疗养院或辅助生活）的患者比独自或与家人居住的患者 LOS 更短（P<0.05）。
接受股骨近端髓内装置或髋关节半髋关节置换术治疗髋部骨折且术前贫血、术后输血、入院至手术天数增加的老年患者 LOS 更长。与 LOS 较长呈正相关的其他因素包括当前吸烟者、营养不良、入院时患有脓毒症以及有血栓栓塞事件史的患者。有趣的是，机构患者的 LOS 比独自或与家人居住的患者更短。
