Background The preoperative stay (PS) in patients with hip fracture has been classically associated with the resultant morbimortality of the process. As a consequence, current clinical guidelines recommend that surgery be performed within 24 or 48 hours of the fracture event. Latest communications question these assumptions.
Objectives To analyze the factors present at the time of admission of patients with hip fracture that determine the length of the PS. Analyze the relationship of the length of the PS with the resultant morbimortality.
Methods From March 1, 2009 to December 31, 2011, all patients admitted with fragility hip fracture in a university hospital, were visited in a prospectively and formalized way. We collected socio-demographic, clinical and analytical data concerning the patient’s status before the fracture, complications arising during admission and follow-up at 3 months and a year. For this study, we analyzed the relationship between the length of the PS, the variables present at admission [age, sex, body mass index (BMI), type of fracture, serum haemoglobin, creatinine, and calcidiol, weekday of admission, Charlson comorbidity index (CI), Pfeiffer test (PT), Barthel index (BI)], the type of surgery and outcome variables [total stay and postoperative stay, one year mortality and worsening of the parameters of functional and cognitive status]. The variables were entered in a database and analyzed with SPSS Windows version 15.0.
Results We included 631 patients (70% women) with a mean age of 83 ± 8 years. On admission, the mean BMI was 25.6 ± 4.5 kg/m2. The mean IC was 1.8 ± 2.0 and IB, 75 ± 29 points. The PT was normal in 54% of patients and showed mild, moderate or severe impairment in 17%, 15% and 14%, respectively. The most prevalent types of fractures were the subcapital (48%) and the pertrochanteric (39%).
Regarding laboratory parameters, mean serum haemoglobin was 11.6 ± 1.9 g/dL, creatinine, 100.9 ± 77.4 mmol/L and calcidiol, 31.6 ± 22.8 nM/L. Osteosynthesis was the most commonly used surgical procedure (60%), prosthetic replacement was performed in 38% of the patients. The mean PS was 4.25 days, postoperative stay 13.4 days and total stay 17.4 days.
One hundred and sixty-five patients (26%) died during the year after the fracture.
None of the variables present at the time of admission or the type of surgery were related to the length of the PS. A longer PS was correlated with significant higher postoperative and total stays. The length of PS was not associated with an increase in the mortality rate or with an impairment of the parameters of functional and cognitive status.
Conclusions In this prospective series of patients with fragility hip fracture, the length of the preoperative stay is not related to the resultant morbimortality. We could not identify any factor that determines preoperative stay length. A longer preoperative stay is associated with higher postoperative and total hospital stays.
Disclosure of Interest None Declared
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