Factors associated with prolonged hospital stay following hip fracture surgery in adults: a multicenter study in Trujillo, Peru
DOI:
https://doi.org/10.58814/01208845.552Keywords:
Hip Fractures, Hospitalization Time, Multicenter Study, Case-control StudiesAbstract
Introduction: Hip fracture (HF) is a highly prevalent health problem with a high morbidity and mortality rate. Most HFs occur in older adults, so hospital stays are often long due to the presence of comorbidities and the increased risk of complications in this age group. To date, there are no studies on the factors associated with this outcome in the Peruvian population.
Objective: To identify the factors associated with prolonged hospital stay following HF surgery in the Peruvian population.
Methodology: A multicenter retrospective case-control study was conducted using data from 1 120 patients who underwent HF surgery in four hospitals in Trujillo (Peru) between 2018 and 2023, with a case-control ratio of 1:1 (140 controls and 140 cases per hospital). Cases were defined as patients with a hospital stay ≥14 days, and the controls as patients with a hospital stay <14 days. Bivariate analyses (chi-square and Mann-Whitney U tests) were performed to evaluate differences between groups (overall and per hospital). A multivariate analysis (bivariate and multivariate binary logistic regression) was performed to identify factors independently associated with prolonged hospital stay.
Results: The factors independently associated with prolonged hospital stay were diabetes mellitus (aOR: 3.058; 95%CI: 2.357 – 3.967; p<0.001), chronic kidney disease (aOR: 3.513; 95%CI: 1.915 – 6.444; p<0.001), preoperative ASA score ≥III (aOR: 1.615; 95%CI: 1.112 - 2.346; p=0.012), and preoperative severe functional dependency (aOR: 6.073; 95%CI: 1.324 – 27.851 p=0.020).
Conclusion: Factors independently associated with prolonged hospital stay following HF surgery in the adult population of northern Peru were diabetes mellitus, chronic kidney disease, preoperative ASA score ≥III, and preoperative severe functional dependency.
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References
Emmerson BR, Varacallo MA, Inman D. Hip Fracture Overview. 2023.In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. PMID: 32491446.
Dong Y, Zhang Y, Song K, Kang H, Ye D, Li F. What was the Epidemiology and Global Burden of Disease of Hip Fractures From 1990 to 2019? Results From and Additional Analysis of the Global Burden of Disease Study 2019. Clin Orthop Relat Res. 2023;481(6):1209-20. doi: 10.1097/CORR.0000000000002465. PMID: 36374576; PMCID: PMC10194687.
Sing CW, Lin TC, Bartholomew S, Bell JS, Bennett C, Beyene K, et al. Global Epidemiology of Hip Fractures: Secular Trends in Incidence Rate, Post-Fracture Treatment, and All-Cause Mortality. J Bone Miner Res. 2023;38(8):1064-75. doi: 10.1002/jbmr.4821. PMID: 37118993.
GBD Results [Internet]. Institute for Health Metrics and Evaluation [Cited 2025 Apr 14]. Available from: https://vizhub.healthdata.org/gbd-results.
Zhang YW, Lu PP, Li YJ, Dai GC, Chen MH, Zhao YK, et al. Prevalence, Characteristics, and Associated Risk Factors of the Elderly with Hip Fractures: A Cross-Sectional Analysis of NHANES 2005--2010. Clin Interv Aging. 2021;16:177-85. doi: 10.2147/CIA.S291071. PMID: 33542622; PMCID: PMC7851483.
Xu BY, Yan S, Low LL, Vasanwala FF, Low SG. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord. 2019;20(1):568. doi: 10.1186/s12891-019-2950-0. PMID: 31775693; PMCID: PMC6882152.
Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, et al. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr. 2016;16(1):158. doi: 10.1186/s12877-016-0332-0. PMID: 27590604; PMCID: PMC5010762.
Irwin SC, Hughes AJ, Sheehan E, Merghani K. Trends in Irish hip fracture surgery over a 7-year period and international registry comparison. Surgeon. 2022;20(2):94-102. doi: 10.1016/j.surge.2021.03.002. PMID: 33879409.
Hip fracture: management [Internet]. London: National Institute for Health and Care Excellence (NICE); 2023. (NICE Clinical Guidelines, No. 124 [Cited 2025 Sep 13]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553768/
American Academy of Orthopaedic Surgeons. Management of Hip Fractures in Older Adults Evidence-Based Clinical Practice Guideline [Internet]. AAOS; 2021 [cited 2025 Sep 13]. Available from: https://www.aaos.org/hipfxcpg.
Nordström P, Bergman J, Ballin M, Nordström A. Trends in Hip Fracture Incidence, Length of Hospital Stay, and 30-Day Mortality in Sweden from 1998-2017: A Nationwide Cohort Study. Calcif Tissue Int. 2022;111(1):21-28. doi: 10.1007/s00223-022-00954-4. PMID: 35166892; PMCID: PMC9232476.
Kristan A, Omahen S, Tosounidis TH, Cimerman M. When does hip fracture surgery delay affects the length of hospital stay? Eur J Trauma Emerg Surg. 2022;48(2):701-708. doi: 10.1007/s00068-020-01565-0. PMID: 33388817.
Lavikainen P, Koponen M, Taipale H, Tanskanen A, Tiihonen J, Hartikainen S, et al. Length of Hospital Stay for Hip Fracture and 30-Day Mortality in People With Alzheimer’s Disease: A Cohort Study in Finland. J Gerontol A Biol Sci Med Sci. 2020;75(11):2184-92. doi: 10.1093/gerona/glaa199. PMID: 32797165; PMCID: PMC7566552.
Schneider AM, Denyer S, Brown NM. Risk Factors Associated With Extended Length of Hospital Stay After Geriatric Hip Fracture. J Am Acad Orthop Surg Glob Res Rev. 2021;5(5):e21.00073. doi: 10.5435/JAAOSGlobal-D-21-00073. PMID: 33945514; PMCID: PMC8099404.
Ferris H, Brent L, Sorensen J. Cost of hospitalisation for hip fracture-findings from the Irish hip fracture database. Osteoporos Int. 2022;33(5):1057-65. doi: 10.1007/s00198-021-06294-7. PMID: 35015086; PMCID: PMC8749353.
Videnza Consultores. Situación actual del sistema de salud peruano [Internet]. Lima: Sociedad de Comercio Exterior del Perú; 2023 [Cited 2024 Nov 20]. Available from: https://www.comexperu.org.pe/upload/articles/publicaciones/situacion-actual-del-sistema-de-salud-peruano-final.pdf.
Pareja-Sierra T, Bartolomé-Martín I, Rodríguez-Solís J, Bárcena-Goitiandia L, Torralba-González De Suso M, Morales-Sanz MD, et al. Factores determinantes de estancia hospitalaria, mortalidad y evolución funcional tras cirugía por fractura de cadera en el anciano. Revista Española de Cirugía Ortopédica y Traumatología (English Edition). 2017; 61(6):427-35. doi: 10.1016/j.recot.2017.06.002.
Ntuli M, Filmalter CJ, White Z, Heyns T. Length of stay and contributing factors in elderly patients who have undergone hip fracture surgery in a tertiary hospital in South Africa. Int J Orthop Trauma Nurs. 2020;37:100748. doi: 10.1016/j.ijotn.2019.100748. PMID: 31932254.
Lari A, Haidar A, AlRumaidhi Y, Awad M, AlMutairi O. Predictors of mortality and length of stay after hip fractures - A multicenter retrospective analysis. Journal of Clinical Orthopaedics & Trauma. 2022; 28:101853. doi: 10.1016/j.jcot.2022.101853.
Long Y, Wang T, Xu X, Ran G, Zhang H, Dong Q, et al. Risk Factors and Outcomes of Extended Length of Stay in Older Adults with Intertrochanteric Fracture Surgery: A Retrospective Cohort Study of 2132 Patients. J Clin Med. 2022;11(24):7366. doi: 10.3390/jcm11247366. PMID: 36555982; PMCID: PMC9784786.
Freeman DH. Applied Categorical Data Analysis. New York: Marcel Dekker, Inc.; 1987.
Trevissón-Redondo B, López-López D, Pérez-Boal E, Marqués-Sánchez P, Liébana-Presa C, Navarro-Flores E, et al. Use of the Barthel Index to Assess Activities of Daily Living before and after SARS-COVID 19 Infection of Institutionalized Nursing Home Patients. Int J Environ Res Public Health. 2021;18(14):7258. doi: 10.3390/ijerph18147258. PMID: 34299709; PMCID: PMC8304574.
World Obesity Federation. World Obesity Atlas 2024. London: World Obesity Federation; 2024. Available from: https://data.worldobesity.org/publications/?cat=22 [Accessed 2025 Sep 12].
Yevenes S, Epulef V, Rocco C, Geisse F, Vial M. Clasificación American Society of Anesthesiologisth Physical Status: Revisión de ejemplos locales - Chile. Rev. Chil. Anest. 2022; 51(3):251-60. doi: 10.25237/revchilanestv5114031424.
van Delden JJM, van der Graaf R. Revised CIOMS International Ethical Guidelines for Health-Related Research Involving Humans. JAMA. 2017;317(2):135-6. doi: 10.1001/jama.2016.18977. PMID: 27923072.
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4. doi: 10.1001/jama.2013.281053. PMID: 24141714.
Colegio Médico del Perú (CMP). Código de Ética y Deontología del CMP. Actualización 2023 [Internet]. Lima: CMP; 2023 [cited 2024 Nov 20]. Available from: https://www.cmp.org.pe/wp-content/uploads/2023/02/Actualizacion-Codigo-de-etica-ultima-revision-por-el-comite-de-doctrina01feb.pdf.
Pech-Ciau BA, Lima-Martínez EA, Espinosa-Cruz GA, Pacho-Aguilar CR, Huchim-Lara O, Alejos-Gómez RA. Fractura de cadera en el adulto mayor: epidemiología y costos de la atención [Hip fracture in the elderly: epidemiology and costs of care]. Acta Ortop Mex. 2021;35(4):341-7. Spanish. PMID: 35139593.
Li L, Bennett-Brown K, Morgan C, Dattani R. Hip fractures. Br J Hosp Med. 2020;81(8):1-10. doi: 10.12968/hmed.2020.0215. PMID: 32845763.
Liu H, Xing F, Jiang J, Chen Z, Xiang Z, Duan X. Random forest predictive modeling of prolonged hospital length of stay in elderly hip fracture patients. Front Med (Lausanne). 2024;11:1362153. doi: 10.3389/fmed.2024.1362153. PMID: 38828234; PMCID: PMC11140010.
Manosroi W, Koetsuk L, Phinyo P, Danpanichkul P, Atthakomol P. Predictive model for prolonged length of hospital stay in patients with osteoporotic femoral neck fracture: A 5-year retrospective study. Front Med (Lausanne). 2023;9:1106312. doi: 10.3389/fmed.2022.1106312. PMID: 36714117; PMCID: PMC9874094.
Camacho Vargas EM, Vargas Morales RE, Caballero Alvarado JA. Factores asociados a la infección del sitio quirúrgico tras hemiartroplastia de cadera. Revista Cubana de Ortopedia y Traumatología. 2024;38. Available from: https://revortopedia.sld.cu/index.php/revortopedia/article/view/817.
Wang PW, Yao XD, Zhuang HF, Li YZ, Xu H, Lin JK, et al. Mortality and Related Risk Factors of Fragile Hip Fracture. Orthop Surg. 2022;14(10):2462-9. doi: 10.1111/os.13417. PMID: 36017769; PMCID: PMC9531092.
Salvador Marín J, Ferrández Martínez FJ, Fuster Such C, Seguí Ripoll JM, Orozco Beltrán D, Carratalá Munuera MC, et al. Factores de riesgo para el ingreso prolongado y mortalidad intrahospitalaria en la fractura del fémur proximal en pacientes mayores de 65 años. Rev Esp Cir Ortop Traumatol. 2021;65(5):322-30. doi: 10.1016/j.recot.2020.11.008.
Schweller E, Mueller J, Santiago Rivera OJ, Villegas SJ, Walkiewicz J. Factors Associated With Hip Fracture Length of Stay Among Older Adults in a Community Hospital Setting. J Am Acad Orthop Surg Glob Res Rev. 2023;7(5):e22.00195. doi: 10.5435/JAAOSGlobal-D-22-00195. PMID: 37134192; PMCID: PMC10155900.
Berbudi A, Rahmadika N, Tjahjadi AI, Ruslami R. Type 2 Diabetes and its Impact on the Immune System. Curr Diabetes Rev. 2020;16(5):442-9. doi: 10.2174/1573399815666191024085838. PMID: 31657690; PMCID: PMC7475801.
Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and Risk of Surgical Site Infection: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1):88-99. doi: 10.1017/ice.2015.249. PMID: 26503187; PMCID: PMC4914132.
Wong JKL, Ke Y, Ong YJ, Li H, Wong TH, Abdullah HR. The impact of preoperative glycated hemoglobin (HbA1c) on postoperative complications after elective major abdominal surgery: a meta-analysis. Korean J Anesthesiol. 2022;75(1):47-60. doi: 10.4097/kja.21295. PMID: 34619855; PMCID: PMC8831432.
Miyake K, Iwagami M, Ohtake T, Moriya H, Kume N, Murata T, et al. Association of pre-operative chronic kidney disease and acute kidney injury with in-hospital outcomes of emergency colorectal surgery: a cohort study. World J Emerg Surg. 2020;15(1):22. doi: 10.1186/s13017-020-00303-6. PMID: 32216810; PMCID: PMC7098074.
Hofer IS, Cheng D, Grogan T. A Retrospective Analysis Demonstrates That a Failure to Document Key Comorbid Diseases in the Anesthesia Preoperative Evaluation Associates With Increased Length of Stay and Mortality. Anesth Analg. 2021;133(3):698-706. doi: 10.1213/ANE.0000000000005393. PMID: 33591117; PMCID: PMC8280237.
Al-Husinat L, Azzam S, Sharie SA, Al Hseinat L, Araydah M, Al Modanat Z, et al. Impact of the American Society of Anesthesiologists (ASA) classification on hip fracture surgery outcomes: insights from a retrospective analysis. BMC Anesthesiol. 2024;24(1):271. doi: 10.1186/s12871-024-02660-0. PMID: 39103787; PMCID: PMC11299364.
Walsh M, Ferris H, Brent L, Ahern E, Coughlan T, Romero-Ortuno R. Development of a Frailty Index in the Irish Hip Fracture Database. Arch Orthop Trauma Surg. 2023;143(7):4447-54. doi: 10.1007/s00402-022-04644-6. PMID: 36210379; PMCID: PMC10293399.
Kwak MJ, Digbeu BD, des Bordes J, Rianon N. The association of frailty with clinical and economic outcomes among hospitalized older adults with hip fracture surgery. Osteoporos Int. 2022;33(7):1477-84. doi: 10.1007/s00198-021-06215-8. PMID: 35178610.
Wong BLL, Chan YH, O’Neill GK, Murphy D, Merchant RA. Frailty, length of stay and cost in hip fracture patients. Osteoporos Int. 2023;34(1):59-68. doi: 10.1007/s00198-022-06553-1. PMID: 36197493.
Lin HS, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. doi: 10.1186/s12877-016-0329-8. PMID: 27580947; PMCID: PMC5007853.
Medina-Sánchez ME. Factores asociados a estancia hospitalaria prolongada tras fractura de cadera: un estudio multicéntrico. [Tesis]. Trujillo: Universidad Privada Antenor Orrego; 2025 [cited 2025 Jun 26]. Available from: https://hdl.handle.net/20.500.12759/59031.
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