Risk Factors for Prolonged Postoperative Length of Stay After Hip Fracture Surgery in Very Elderly Patients

Bo-Wen Xu; Wei-Yun Chen; Chen Sun; Ling Lan; Lu-Lu Ma; Li-Jian Pei

doi:10.24920/004465

Your Location：

Home >

Browse articles >

Risk Factors for Prolonged Postoperative Length of Stay After Hip Fracture Surgery in Very Elderly Patients

Chinese Medical Sciences Journal Vol. 40, Issue 2, Pages: 111-119(2025)

Research Article | Updated：2025-09-02

- Risk Factors for Prolonged Postoperative Length of Stay After Hip Fracture Surgery in Very Elderly Patients
- Affiliations：
  
  Department of Anesthesiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing 100730, China
- Author bio：
  
  E-mail: hazelbeijing@vip.163.com
- Funds：
- DOI：10.24920/004465
  CLC：
- Received：13 January 2025，
  
  Accepted：10 April 2025，
  
  Published Online：03 June 2025，
  
  Published：30 June 2025
- Accepted：
Scan QR Code
徐博文,陈唯韫,孙琛等.超高龄患者髋部骨折术后住院时间延长的危险因素[J].中国医学科学杂志（英文）,2025,40(02):111-119.doi: 10.24920/004465

Xu Bo-Wen,Chen Wei-Yun,Sun Chen,et al.Risk Factors for Prolonged Postoperative Length of Stay After Hip Fracture Surgery in Very Elderly Patients[J].Chinese Medical Sciences Journal,2025,40(02):111-119.doi: 10.24920/004465
徐博文,陈唯韫,孙琛等.超高龄患者髋部骨折术后住院时间延长的危险因素[J].中国医学科学杂志（英文）,2025,40(02):111-119.doi: 10.24920/004465 DOI：

Xu Bo-Wen,Chen Wei-Yun,Sun Chen,et al.Risk Factors for Prolonged Postoperative Length of Stay After Hip Fracture Surgery in Very Elderly Patients[J].Chinese Medical Sciences Journal,2025,40(02):111-119.doi: 10.24920/004465 DOI：

摘要

背景

本研究旨在确定超高龄患者髋部骨折术后住院时间延长的危险因素，重点关注术后并发症以及不同麻醉方式对术后住院时间的影响。

方法

这项回顾性单中心队列研究纳入了2013年1月31日至2023年12月31日在北京协和医院接受髋部骨折手术的90岁及以上老年患者。收集相关围手术期数据。主要结局指标为术后住院时间，并根据术后住院时间将研究队列分为两组：术后住院时间≤7天组和＞7天组。采用逻辑回归分析确定与术后住院时间延长相关的危险因素。

结果

共纳入155例患者。平均年龄为（92.7±2.6）岁。73（47%）例患者的术后住院时间超过7天。术后住院时间＞7天与肺炎相关（

= 2.12，95%

［1.09， 4.16］，

= 0.028）。麻醉方式（相比于全身麻醉，区域麻醉

= 1.00，95%

［0.53， 1.90］，

= 0.993）、气道管理方式（相比于面罩/鼻导管给氧，喉罩通气

= 1.46，95%

［0.58，3.76］，

= 0.424，气管插管通气

= 0.82，95%

［0.39，1.69］，

= 0.592）与术后住院时间＞7天均无显著相关性。术前合并慢性阻塞性肺疾病（

= 2.78，95%

［1.05，7.65］，

= 0.040）和术前中性粒细胞计数（

= 1.13，95%

［1.01，1.26］，

= 0.029）与术后肺炎的发生相关，而麻醉方式和气道管理方式则与之无显著相关性。

结论

术后肺炎与超高龄髋部骨折患者术后住院时间延长相关，而麻醉方式、气道管理方式与术后住院时间延长或术后肺炎无显著相关性。术前合并症，尤其是呼吸系统疾病和全身性炎症，可能会对术后恢复构成重大影响。

Abstract

Objective

To identify risk factors contributing to prolonged postoperative length of stay (LOS) in very elderly patients following hip fracture surgery

with a focus on postoperative complications and the impact of different anesthesia approaches.

Methods

This retrospective single-center cohort study enrolled patients aged 90 years or older who underwent hip fracture surgery at Peking Union Medical College Hospital between January 31

2013 and December 31

2023. Relevant perioperative data were collected. The primary outcome was postoperative LOS

and the study cohort was divided into two groups: postoperative LOS ≤ 7 days and LOS > 7 days. Logistic regression was performed to identify factors related to prolonged postoperative LOS.

Results

A total of 155 patients were included. The average age was 92.7 ± 2.6 years. There were 73 (47%) patients with postoperative LOS

7 days. Postoperative pneumonia was the only factor associated with a prolonged postoperative LOS (

= 2.12

95%

[1.09

4.16

]

= 0.028). Neither the type of anesthesia (regional vs. general anesthesia

OR =

1.00

95%

[0.53

1.90

]

= 0.993) nor the method of airway management (laryngeal mask ventilation vs. spontaneous breathing

= 1.46

95%

[0.58

3.76

]

= 0.424; endotracheal intubation vs. spontaneous breathing

OR =

0.82

95%

[0.39

1.69

]

= 0.592) showed a significant association with a prolonged postoperative LOS. Preoperative chronic obstructive pulmonary disease (

= 2.78

95%

[1.05

7.65

]

= 0.040) and preoperative neutrophil count (

= 1.13

95%

[1.01

1.26

]

= 0.029) were both significantly associated with the occurrence of postoperative pneumonia

while anesthesia type and airway management method were not.

Conclusions

Postoperative pneumonia was associated with prolonged postoperative LOS in very elderly patients undergoing hip fracture surgery

whereas anesthesia types and airway management methods show no association with prolonged postoperative LOS or postoperative pneumonia. Preoperative comorbidities

especially respiratory conditions and systemic inflammation

potentially play a substantial role in postoperative recovery.

关键词

Keywords

references

Sing CW , Lin TC , Bartholomew S , 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 http://dx.doi.org/10.1002/jbmr.4821 .

Bhandari M , Swiontkowski M . Management of acute hip fracture . N Engl J Med 2017 ; 377 ( 21 ):‍ 2053 - 62 . doi: 10.1056/NEJMcp1611090 http://dx.doi.org/10.1056/NEJMcp1611090 .

Gao F , Liu G , Ge Y , et al . Orthogeriatric co-managements lower early mortality in long-lived elderly hip fracture: a post-hoc analysis of a prospective study . BMC Geriatr 2023 ; 23 ( 1 ): 571 . doi: 10.1186/s12877-023-04289-z http://dx.doi.org/10.1186/s12877-023-04289-z .

Li X , Gong X , He L , et al . Current surgical status of hip fracture among elderly in China . Injury 2024 ; 55 ( 2 ): 111083 . doi: 10.1016/j.injury.2023.111083 http://dx.doi.org/10.1016/j.injury.2023.111083 .

Tiso D , Pizzonia M , Giannotti C , et al . Ultra-old patients and long-term survival after hip fracture: a real-world assessment . Front Med (Lausanne) 2023 ; 10 : 1200007 . doi: 10.3389/fmed.2023.1200007 http://dx.doi.org/10.3389/fmed.2023.1200007 .

Neuman MD , Rosenbaum PR , Ludwig JM , et al . Anesthesia technique, mortality, and length of stay after hip fracture surgery . JAMA 2014 ; 311 ( 24 ):‍ 2508 - 17 . doi: 10.1001/jama.2014.6499 http://dx.doi.org/10.1001/jama.2014.6499 .

Schweller E , Mueller J , Santiago Rivera OJ , et al . 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 http://dx.doi.org/10.5435/JAAOSGlobal-D-22-00195 .

Thornburgh Z , Samuel D . Factors influencing length of stay and discharge destination of patients with hip fracture rehabilitating in a private care setting . Geriatrics (Basel) 2022 ; 7 ( 2 ): 44 . doi: 10.3390/geriatrics7020044 http://dx.doi.org/10.3390/geriatrics7020044 .

Burguêz D , Menegatti R , Susin FO , et al . Evaluation of the surgical treatment of patients over 90 years old with hip fractures and their morbidity and mortality . Rev Bras Ortop (Sao Paulo) 2024 ; 59 ( 1 ):‍ e88 - e92 . doi: 10.1055/s-0044-1779684 http://dx.doi.org/10.1055/s-0044-1779684 .

Leal JA , Garcia LF , Peña OR , et al . Patients aged ninety years and older are exposed to increased risk of one-year mortality after hip fractures . Eur J Orthop Surg Traumatol 2021 ; 31 ( 7 ): 1501 - 6 . doi: 10.1007/s00590-021-02918-0 http://dx.doi.org/10.1007/s00590-021-02918-0 .

Kunutsor SK , Hamal PB , Tomassini S , et al . Clinical effectiveness and safety of spinal anaesthesia compared with general anaesthesia in patients undergoing hip fracture surgery using a consensus-based core outcome set and patient-and public-informed outcomes: a systematic review and meta-analysis of randomised controlled trials . Br J Anaesth 2022 ; 129 ( 5 ):‍ 788 - 800 . doi: 10.1016/j.bja.2022.07.031 http://dx.doi.org/10.1016/j.bja.2022.07.031 .

Neuman MD , Feng R , Carson JL , et al . Spinal anesthesia or general anesthesia for hip surgery in older adults . N Engl J Med 2021 ; 385 ( 22 ): 2025 - 35 . doi: 10.1056/NEJMoa2113514 http://dx.doi.org/10.1056/NEJMoa2113514 .

Guo WD , Li Y , Li JH , et al . Effects of neuraxial or general anaesthesia on postoperative adverse events in oldest-old patients (aged 90 years and older) with intertrochanteric fractures: a retrospective study . BMC Musculoskelet Disord 2023 ; 24 ( 1 ): 834 . doi: 10.1186/s12891-023-06973-y http://dx.doi.org/10.1186/s12891-023-06973-y .

de Groot R , Nijmeijer WS , Folbert EC , et al . 'Nonagenarians' with a hip fracture: is a different orthogeriatric treatment strategy necessary? Arch Osteoporos 2020 ; 15 ( 1 ): 19 . doi: 10.1007/s11657-020-0698-7 http://dx.doi.org/10.1007/s11657-020-0698-7 .

Zhao K , Zhang J , Li J , et al . In-hospital postoperative pneumonia following geriatric intertrochanteric fracture surgery: incidence and risk factors . Clin Interv Aging 2020 ; 15 : 1599 - 609 . doi: 10.2147/CIA.S268118 http://dx.doi.org/10.2147/CIA.S268118 .

Yu Y , Zheng P . Determination of risk factors of postoperative pneumonia in elderly patients with hip fracture: what can we do? PLoS One 2022 ; 17 ( 8 ):‍ e0273350 . doi: 10.1371/journal.pone.0273350 http://dx.doi.org/10.1371/journal.pone.0273350 .

Odor PM , Bampoe S , Gilhooly D , et al . Perioperative interventions for prevention of postoperative pulmonary complications: systematic review and meta-analysis . BMJ 2020 ; 368 : m540 . doi: 10.1136/bmj.m540 http://dx.doi.org/10.1136/bmj.m540 .

Xu L , Yang M , Zhang X , et al . The cost-effectiveness of a co-managed care model for elderly hip fracture patients in China: a modelling study . Lancet Reg Health West Pac 2024 ; 49 : 101149 . doi: 10.1016/j.lanwpc.2024.101149 http://dx.doi.org/10.1016/j.lanwpc.2024.101149 .

Liu G , Yang MH , Zhu SW , et al . Effect of orthogeriatric co-management on geriatric hip fractures in China . Orthop Surg 2022 ; 14 ( 4 ): 671 - 7 . doi: 10.1111/os.13233 http://dx.doi.org/10.1111/os.13233 .

Torrance HD , Zhang P , Longbottom ER , et al . A transcriptomic approach to understand patient susceptibility to pneumonia after abdominal surgery . Ann Surg 2024 ; 279 ( 3 ): 510 - 20 . doi: 10.1097/SLA.0000000000006050 http://dx.doi.org/10.1097/SLA.0000000000006050 .

Knio ZO , 3rd Clancy PW , Zuo Z . Effect of spinal versus general anesthesia on thirty-day outcomes following total hip arthroplasty: a matched-pair cohort analysis . J Clin Anesth 2023 ; 87 : 111083 . doi: 10.1016/j.jclinane.2023.111083 http://dx.doi.org/10.1016/j.jclinane.2023.111083 .

Tian Y , Zhu Y , Zhang K , et al . Incidence and risk factors for postoperative pneumonia following surgically treated hip fracture in geriatric patients: a retrospective cohort study . J Orthop Surg Res 2022 ; 17 ( 1 ): 179 . doi: 10.1186/s13018-022-03071-y http://dx.doi.org/10.1186/s13018-022-03071-y .

Chen WQ , Guo N , Wang SS , et al . General laryngeal mask airway anesthesia with lumbar plexus and sciatic block provides better outcomes than general anesthesia and endotracheal intubation in elderly patients undergoing hip surgery . Arch Gerontol Geriatr 2018 ; 78 :‍ 227 - 32 . doi: 10.1016/j.archger.2018.07.005 http://dx.doi.org/10.1016/j.archger.2018.07.005 .

Pincus D , Ravi B , Wasserstein D , et al . Association between wait time and 30-day mortality in adults undergoing hip fracture surgery . JAMA 2017 ; 318 ( 20 ): 1994 - 2003 . doi: 10.1001/jama.2017.17606 http://dx.doi.org/10.1001/jama.2017.17606 .

Klestil T , Röder C , Stotter C , et al . Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis . Sci Rep 2018 ; 8 ( 1 ):‍ 13933 . doi: 10.1038/s41598-018-32098-7 http://dx.doi.org/10.1038/s41598-018-32098-7 .

Views

Downloads

Scopus

Alert me when the article has been cited

Submit

Publicity Resources

No data

Related Author

No data

Related Institution

No data

⁰