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

To define factors influencing length of hospital stay (LOS) besides surgery delay.

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.

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.

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.