Factors influencing postoperative LOS after fragility hip fracture surgery: public perceptions – a mixed methods study

Abstract

Background Postoperative patient outcomes after hip fracture are significant to patients and their relatives, clinicians and policy makers. However, little is known about the collective views of these stakeholders on postoperative factors perceived to cause prolonged hospitalisation in this patient population. We aimed to explore individual stakeholders’ opinions on factors influencing timing of discharge.Methods Using a mixed methods approach, healthcare professionals, patients and relatives completed a questionnaire and interviews. The questionnaire consisted of 13 morbidity and non-medical domains on a five-point Likert scale. Participants were asked to rank each item identifying its importance in influencing length of hospital stay; 1 = strongly disagree, 2 = disagree, 3 = neither disagree nor agree, 4 = agree, 5 = strongly agree. Interviews were semi-structured exploring participant perceptions.Findings Twenty-six participants completed both interviews and questionnaires; three completed questionnaires only. Five themes affecting LOS emerged from interview data analysis; medical conditions, age and frailty, psychological aspects, the recovery process and social issues. There were some differences between the importance attributed by the semi-quantitative rating scales and the qualitative themes generated. Quantitative data suggested medical factors (pulmonary, infectious, gastrointestinal, cardiovascular, neurological, haematological, wound and pain). The interviews however highlighted functional and social aspects of recovery as key for patients and relative participants.Conclusion Recovery and discharge from hospital following hip fracture is understood by patients, carers or staff to be a complex interplay between medical conditions, psychosocial factors and the practicalities of living with increased dependency. Approaches to improving outcome will need to address each of these domains if they are to be effective.