EFFECT OF TIME TO SURGERY AND CO-MORBIDITIES ON LENGTH OF STAY IN FRACTURED NECK OF FEMUR PATIENTS

Abstract

A prospective audit was carried out to analyse the relationship between time to surgery, number of co-morbidities and length of stay in 357 consecutive patients operated on for a fractured neck of femur.

One hundred and thirty five patients were operated on within 48 hours (group 1), 129 between 48 and 96 hours (group 2) and 93 patients after 96 hours (group 3). The mean (std dev) age was 77.2 (12.5) years in group 1, 79.8 (9.9) years in group 2 and 79.2 (9.4) in group 3. There were 93 (69%) females in group 1, 99 (77%) in group 2 and 67 (72%) in group 3. The number (%) admitted from home was 85 (63) in group 1, 81 (63) in group 2 and 73 (79) in group 3.

In the 30 patients with no co-morbidities there was a strong relationship between wait for surgery and length of stay. In these patients the median length of stay increased from 8.5 days in group 1 to 21 days when in group 3. In the 187 patients with one or two co-morbidities the relationship was present but weaker. The median length of stay increased from 16 days in group 1 to 21 days when in group 3. In the 140 patients with 3 or more co-morbidities there was no relationship between wait for surgery and length of stay. Median length of stay was 23 days in group 1 and 21 days in group 3.

This data from a large consecutive group of patients suggests that the fit patient with a hip fracture benefits from early surgery with a shorter length of stay. Those with multiple co-morbidities have their length of stay determined by their medical condition.