CAUSES OF PROLONGED STAY FOLLOWING LOW-ENERGY FRACTURE OF THE PROXIMAL FEMUR: ISSUES OF MOST CONCERN

Abstract

Introduction: Proximal femur fractures are an important cause of morbidity in the elderly and comprise a significant proportion of acute orthopaedic admissions.

Aim: To study the demographics of and factors responsible for prolonged hospital stay following admission with a fractured neck of femur.

Methods: We reviewed of a consecutive series of hip fractures presenting to our unit over a five-year period between 2000 and 2004. A complete patient cohort was obtained from the casualty register, the OT register and from a Hospital In-Patient Enquiry (HIPE) database. Pathological, high energy and peri-prosthetic fractures were excluded. We reviewed records to obtain demographic and clinical data including age, sex, length of stay, time to operation and comorbidities. Those who remained in-patients for greater than 14 days were analysed for reasons responsible for prolonged stay.

Results: 717 low-energy hip fractures treated in the period 2000–2004. The M:F ratio was 1:3.3. The average age for males and females was 73.6 yrs (SD 11.23) and 79.6 yrs (SD 9.74) respectively. The overall average length of stay was 28 days. 351 patients (49%) stayed in hospital > 14 days. For these, the mean length of stay was 48 days (range 15–443). Reasons for prolonged stay included acute medical and surgical issues (32%), social and placement issues (22%), active chronic disease (17%) and post-operative complications (4%).

Conclusion: Hip fractures in the elderly constitute a significant burden on an acute trauma service. Further strategies are needed to address both medical and social reasons for prolonged stay in and delayed discharge from hospital. A national hip fracture audit is required.