Correlation Analysis Of Factors Affecting Length Of Hospitalization For Hip Fracture In Elderly Patients

ObjectiveThis study collects clinical data of elderly patients with hip fractures,including femoral neck fractures and intertrochanteric fractures admitted in the First Department of Orthopedics,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,aiming to explore potential factors influencing the length of stay in these patients,thus providing scientific references for using the theory of enhanced recovery after surgery(ERAS),shortening the length of stay,reducing medical cost and reasonable use of medical resources in elderly patients with hip fractures.MethodsA total of 201 elderly patients with hip fractures,including femoral neck fractures and intertrochanteric fractures admitted in the First Department of Orthopedics,The First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2018 to December 2019 were retrospectively recruited.Their perioperative data were recorded,processed using Excel,and statistically analyzed using SPSS 25.0.Continuous variables were expressed as (?)±s,and categorical variables were expressed as n(%).Differences in continuous variables,including the age,waiting period(the time from admission to surgery),hemoglobin level at admission,white cell count at admission,body mass index(BMI)and prognostic nutritional index(PNI)were compared by the Pearson’s correlation test.Differences in categorical variables,including the gender,lesion site,fracture subtype,usage of traditional Chinese medicine,ASA physical status classification,Charlson comorbidity index(CCI),medical insurance,admission at the weekend,residence in Guangzhou and physician qualification were compared by the Student’s t test.Variables with significant differences in the univariate analysis were introduced into the multivariate analysis,thus obtaining independent risk factors affecting the length of stay for elderly patients with hip fractures.P<0.05 was considered as statistically significant.ResultsA total of 201 elderly patients with hip fractures were eligibly recruited in this study.The age,gender,lesion site,waiting period,hemoglobin level at admission,white cell count at admission,PNI,CCI,ASA physical status classification,BMI,fracture subtype,usage of traditional Chinese medicine,medical insurance,admission at the weekend,residence in Guangzhou,and physician qualification were included for analyses.The univariate analysis on continuous variables showed that waiting period,hemoglobin level at admission and PNI were significantly correlated to the length of stay in elderly patients with hip fractures.In addition,the univariate analysis on categorical variables showed that the length of stay in elderly patients with hip fractures of ASA 1-2 was significantly shorter than those with ASA 3-4(17.22±6.80 d vs.19.48± 8.02 d,t=-2.117,P=0.035<0.05).The average length of stay was significantly shorter in elderly patients with hip fractures who had medical insurance than those at their own expense(17.47±7.85 d vs.19.70±7.10 d,t=-2.094,P=0.038<0.05).In addition,the average length of stay was significantly shorter in elderly patients with 0 of CCI than those with CCI > 0(16.26±6.08 d vs.19.31±7.92 d,t=-2.890,P=0.005<0.05).After introducing the waiting period,hemoglobin level at admission,PNI,ASA physical status classification,CCI and medical insurance with significant differences in the univariate analysis,the univariate analysis yielded the conclusion that the waiting period,hemoglobin level at admission and PNI were independent risk factors affecting the length of stay for elderly patients with hip fractures.ConclusionElderly patients with hip fractures who have a longer waiting period for surgery,lower hemoglobin level at admission,lower PNI,ASA 3-4,CCI>0 or at own expense are indicated to have a longer length of stay.Waiting period for surgery,hemoglobin level at admission and PNI are direct independent risk factors for the long length of stay in elderly patients with hip fractures.It is necessary to adopt the theory of enhanced recovery after surgery(ERAS)by perfecting preoperative examination as soon as possible,correcting anemia,improving preoperative nutritional status,performing multidisciplinary consultation,and off-bed activities in the early stage,thus reducing length of stay and medical cost for a better rational usage of medical resources.