Authors (including presenting author) :
Cheung EYY(1), Chan ACM(2), Chau RMW(1), Chan JSP(1), Wong EYW(1), Cheung LPC(3), Cheng WKH(3), Li KK(3), Li W(3)
Affiliation :
(1)Physiotherapy Department, Kowloon Hospital,(2)Physiotherapy Department, Queen Elizabeth Hospital,(3)Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital
Introduction :
Hip fracture is a common consequence after fall in elderly requiring hospitalization and surgery. Although better functional recovery may be achieved after longer in-patient rehabilitation program, prolonged length of stay (LOS) can lead to assess block, increased risk of infection during hospitalization as well as post-discharge mortality.
Objectives :
The aim of the current study is to identify pre-operative risk factors for prolonged LOS in acute hospital for people with hip fracture.
Methodology :
Patients admitted to Queen Elizabeth Hospital with principle diagnosis of hip fracture were recruited. Patients with surgery received after 48 hours of admission due to unstable medical conditions were excluded. Past medical histories, Charlson Comorbidity Index, Functional Comorbidity Index, Functional Prognosis Predictive Score, Morse Fall Scare, bone mineral density and any associated fractures were collected upon admission. Pre-operative fever was also recorded. Length of stay was recorded and 10 days was adopted as the cutoff.
Result & Outcome :
From January to December 2016, total of 630 subjects with mean age of 83.76±7.22 years old were recruited (27.6% were male). Binary logistic regression with backward method using Likelihood estimation method was used to assess the risk factors for prolonged LOS with p-value set at 0.1. The equation of the final model of binary logistic regression was:
Logit(LOS>10) = 0.627(Cardiovascular Disease) + 0.709(Heart Disease) + 1.247(Osteoporosis) + 0.821(Renal Impairment) + 1.066(Pre-operative fever) – 1.192
The current result suggests that patients with poor pre-operative physical ability due to cardiovascular disease, heart disease, and fever may have higher risk for prolonged LOS. Patients with hip fracture are more likely suffering from osteoporosis which further increases the risk of prolonged hospitalization. Renal impairment may limit the use of analgesics leading to poor pain control and hinder rehabilitation progress. Enhancement opportunity in early non-pharmacological pain management, including the use of electro-physical modalities and early mobilization, for this clientele may help to relief pain and boost the rehabilitation engine. Active participation in rehabilitation program for hip fracture patients can fasten physical recovery, prevent further deterioration of bone density and may help to alleviate LOS issues in fragility fracture management.
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