Risk Factors Associated With Extended Length of Hospital Stay After Geriatric Hip Fracture

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.