A predictive model for increased hospital length of stay following geriatric hip fracture
Olivia M Knoll1, Nikita Lakomkin2, Michelle S Shen3
1The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200 Medical Center East, South Tower Nashville, TN, 37232, USA.
Insights
Hypertension, disseminated cancer, admission to medicine service, and male sex are key factors influencing hospital length of stay (LOS) after geriatric hip fracture. These findings can aid in predicting and managing patient recovery times.
Area of Science:
- Geriatric Orthopaedic Surgery
- Trauma Care
- Health Services Research
Background:
- Geriatric hip fractures represent a significant clinical challenge, impacting patient mobility and healthcare resource utilization.
- Understanding factors influencing hospital length of stay (LOS) is crucial for effective patient management and resource allocation.
Purpose of the Study:
- To identify significant risk factors associated with hospital length of stay (LOS) following geriatric hip fracture.
- To develop a predictive model for LOS using identified significant variables.
Main Methods:
- Retrospective study of 614 patients treated for geriatric hip fracture.
- Negative binomial regression analysis to identify perioperative variables associated with LOS.
Main Results:
- Hypertension (IRR: 1.10), disseminated cancer (IRR: 1.24), admission to medicine service (IRR: 1.48), and male sex (IRR: 1.09) were independently associated with prolonged LOS.
- The developed LOS formula accurately estimated actual LOS within 3 days for 75.8% of patients.
Conclusions:
- Several comorbidity and perioperative variables significantly impact LOS in geriatric hip fracture patients.
- The developed LOS model can assist in risk stratification for orthopaedic trauma patients with hip fractures.
Background:
The purpose of this study was to identify the risk factors that are significantly associated with hospital length of stay (LOS) following geriatric hip fracture and to use these significant variables to develop a LOS calculator.
Materials And Methods:
This was a retrospective study examining 614 patients treated for geriatric hip fracture between January 2000 and December 2009 at an urban, Level 1 trauma center. A negative binomial regression analysis was used to identify perioperative variables associated with hospital LOS.
Results:
614 patients met the inclusion criteria, presenting with a mean age of 78 (±10) years. The most common pre-operative comorbidity was hypertension, followed by diabetes and COPD. After controlling for all collected comorbidities as well as demographics and operative variables, hypertension (IRR: 1.10, p = 0.029) and disseminated cancer (IRR: 1.24, p = 0.007) were found to be significantly associated with LOS. In addition, two demographic/presenting variables, admission to the medicine service (IRR: 1.48, p < 0.001) and male sex (IRR: 1.09, p = 0.034), were shown to be independent risk factors for prolonged LOS. These variables were synthesized into a LOS formula, which estimated LOS to within 3 days of the true length of stay for 0.758 of the series (95% confidence interval: 0.661 to 0.855).
Conclusions:
This study identified several comorbidity and perioperative variables that were significantly associated with LOS following geriatric hip fracture surgery. The resulting LOS model may have utility in the risk stratification of orthopaedic trauma patients presenting with hip fracture.
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