Determinants of Length of Stay in Geriatric Intertrochanteric Femur Fractures

Abstract

Objective: To investigate the clinical and administrative factors associated with hospital length of stay in geriatric patients with operative intertrochanteric femur fractures.

Design: Retrospective cohort study.

Setting: Level I tertiary facility and Community Hospital.

Participants: A total of 152 patients 65 years of age or older who were operatively treated for intertrochanteric fractures between 2014-2019.

Intervention: Transfusion in operative intertrochanteric femur fractures.

Main Outcome Measurements: The primary outcome was prolonged length of stay (LOS) defined as greater than or equal to 5 days.

Results: A total of 115/152 (75%) had preoperative anemia defined as hematocrit <36.0% for women or 41.0% for men.The prevalence of transfusion was 26% in these geriatric patients with operative intertrochanteric fractures. Among the cohort, 87 (57%) participants had a prolonged length of stay. The average length of stay was not different between those with or without anemia (6.6 days versus 6.5 days, p = .85). Among those participants admitted on a Wednesday, 89% had a prolonged length of stay (p = .001). Anesthesiology Specialty Association (ASA) classification was significantly associated with length of stay (p<0.04). Location of surgery was significantly associated with a prolonged length of stay (p = .001).

Conclusion: The present study suggests preoperative hematocrit is not associated with a prolonged LOS in geriatric patients with hip surgery. Wednesday admissions and ASA scores were independent variables associated with LOS and should be considered in bundled payments and discharge planning from the time of admission.