Predictive Modeling for Geriatric Hip Fracture Patients: Early Surgery and Delirium Have the Largest Influence on Length of Stay

Hecht, Garin; Goodell, P. B.; Taylor, Sandra L.; Wolinsky, Philip R

doi:10.5435/jaaos-d-17-00447

Cited by 20 publications

(13 citation statements)

References 26 publications

(34 reference statements)

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“…They stated that the timeliness of surgical intervention in this population causes no effect on overall complications, readmissions, or 30-day mortality, but an admission-to-operation time of >48 hours is associated with costly increases in LOS. Hecht et al 15 developed a predictive model for LOS in geriatric hip fracture patients and found that for each day surgery was delayed, LOS increased by 0.75 days. The totality of the results of from our study and aforementioned studies suggest that hospitals and provider teams continue to investigate possible interventions to mitigate unnecessary delays to surgery.…”

Section: Discussionmentioning

confidence: 99%

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

2021

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Introduction: 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. Methods: 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. Results: 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). Discussion: 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.

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Section: Discussionmentioning

confidence: 99%

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

2021

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“…Previous studies have examined hip fractures admitted to trauma centers or examined national healthcare databases. 9 10 11 12 13 Their findings have been helpful in the evaluation of processes and procedures at larger tertiary care centers and have been informative in establishing clinical operating guidelines, including the use of dedicated orthogeriatric comanagement. 12 , 14 However, these resources are not always readily available at smaller community-based hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…Notably, in 2019, Hecht, et. al 10 published a report attempting to construct a predictive model for geriatric hip fracture patients. They found that reduced time to surgery and absence of delirium were predictors of shorter LOS.…”

Section: Discussionmentioning

confidence: 99%

“…They found that reduced time to surgery and absence of delirium were predictors of shorter LOS. 10 In addition, they reported an average LOS of patients undergoing hip fracture surgical repair of 5.95 days in their retrospective trial at the UC Davis Geriatric Fracture Program. The findings of Hecht and colleagues are in concordance with the result of our community hospital settings, where the average LOS was 5.36 days, and where reduced time to surgery was associated with a lower median LOS.…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated With Hip Fracture Length of Stay Among Older Adults in a Community Hospital Setting

et al. 2023

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Introduction: Hip fractures in geriatric populations constitute a heavy burden on the healthcare system. The study goal was to identify patient, hospital, and surgical factors associated with hospital length of stay (LOS) for geriatric patients with hip fractures requiring surgical intervention in a community hospital setting. Methods: This was a cross-sectional retrospective chart review of geriatric hip fractures that underwent surgical fixation at a community hospital between 2017 and 2019. The scope of the surgeries was limited to cephalomedullary device fixation or hemiarthroplasty hip fracture surgeries. Sliding hip screw or total hip arthroplasty procedures and patients who died during the index hospitalization were excluded. Median tests were conducted to examine differences between the groups. Unadjusted and adjusted truncated negative binomial regression models were used to examine the factors associated with LOS. Results: Bivariate analyses revealed results that the factors associated with a longer LOS were preoperative anemia ( P = 0.029), blood transfusion ( P = 0.022), and the number of days between admission and surgery ( P = 0.001). The adjusted regression model results suggested that older patients, patients who underwent surgery more than one day after admission, current smokers, malnourished patients, patients with sepsis, and patients with a history of a thromboembolic event had statistically significant ( P < 0.05) longer LOS. However, patients who live in institutions (nursing homes or assisted living) had a shorter LOS than those who live at home alone or with family ( P < 0.05). Discussion: Older adult patients who underwent surgery with a cephalomedullary device or hip hemiarthroplasty for a hip fracture and had preoperative anemia, postoperative blood transfusions, and increased days between admission and surgery had a longer LOS. Additional factors positively associated with a longer LOS included current smokers, malnourishment, admission with sepsis, and patients with a history of a thromboembolic event. Of interest, institutionalized patients had a shorter LOS than those living at home alone or with family.

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“…A critical factor in reducing morbidity in hip fractures is timely surgery. 34 - 38 To achieve this, the Orthopaedic Trauma Service—comprised of fellowship-trained employed faculty—was invited to participate in the program. As the hospital is also a level I trauma center, this created availability for an all-day trauma room during the week.…”

Section: Methodsmentioning

confidence: 99%

Implementing a Geriatric Fracture Program in a Mixed Practice Environment Reduces Total Cost and Length of Stay

Lin

Rosen

Breda

et al. 2021

Geriatr Orthop Surg Rehabil

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Introduction: Geriatric-orthopaedic co-management models can improve patient outcomes. However, prior reports have been at large academic centers with “closed” systems and an inpatient geriatric service. Here we describe a Geriatric Fracture Program (GFP) in a mixed practice “pluralistic” environment that includes employed academic faculty, private practice physicians, and multiple private hospitalist groups. We hypothesized GFP enrollment would reduce length of stay (LOS), time to surgery (TTS), and total hospital costs compared to non-GFP patients. Materials and Methods: A multidisciplinary team was created around a geriatric Nurse Practitioner (NP) and consulting geriatrician. Standardized geriatric focused training programs and electronic tools were developed based on best practice guidelines. Fracture patients >65 years old were prospectively enrolled from July 2018 – June 2019. A trained biostatistician performed all statistical analyses. A p < 0.05 was considered significant. Results: 564 operative and nonoperative fractures in patients over 65 were prospectively followed with 153 (27%) enrolled in the GFP and 411 (73%) admitted to other hospitalists or their primary care provider (non-GFP). Patients enrolled in the GFP had a significantly shorter median LOS of 4 days, compared to 5 days in non-GFP patients (P < 0.001). There was a strong trend towards a shorter median TTS in the GFP group (21.5 hours v 25 hours, p = 0.066). Mean total costs were significantly lower in the GFP group ($25,323 v $29085, p = 0.022) Discussion: Our data shows that a geriatric-orthopaedic co-management model can be successfully implemented without an inpatient geriatric service, utilizing the pre-existing resources in a complex environment. The program can be expanded to include additional groups to improve care for entire geriatric fracture population with significant anticipated cost savings. Conclusions: With close multidisciplinary team work, a successful geriatric-orthopaedic comanagement model for geriatric fractures can be implemented in even a mixed practice environment without an inpatient geriatrics service.

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Predictive Modeling for Geriatric Hip Fracture Patients: Early Surgery and Delirium Have the Largest Influence on Length of Stay

Cited by 20 publications

References 26 publications

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

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

Factors Associated With Hip Fracture Length of Stay Among Older Adults in a Community Hospital Setting

Implementing a Geriatric Fracture Program in a Mixed Practice Environment Reduces Total Cost and Length of Stay

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