External fixation and discharge destination are independent risk factors for a prolonged hospital stay in elderly patients with a fragility fracture, according to a new study.
Certain Risk Factors Can Predict Longer Hospital Stay
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Secondary#externalfixation#fragilityanklefracture#lengthofhospitalstay
The study, “Factors Affecting Hospital Length of Stay in Geriatric Patients With a Surgically Treated Fragility Ankle Fracture,” was published in the May 1, 2022 issue of The Journal of Foot and Ankle Surgery.
“Fragility ankle fractures in elderly have a rising incidence and hospitalization may be prolonged due to pre-existing comorbidities, compromised soft tissue and postoperative difficulties in the rehabilitation process.,” the researchers wrote.
In their retrospective cohort study, they wanted to determine the risk factors for longer total hospital stay in elderly patients with surgically treated fragility (Lauge Hansen supination external rotation type 4) fractures.
The study included all patients 70 years of age and older who were treated surgically between 2011 and 2019 in level 1 and 2 trauma centers. There was a total of 97 patients.
The researchers collected data on patient demographics, fracture characteristics, surgical treatment strategies and postoperative complications.
The mean age of the patients was 78.27 (±6.56) years; 71 patients (73.20%) were female. Ten of the fractures were classified as open and 49 as a luxation type fracture. Fifty-nine of the patients were hospitalized after admission to the emergency department.
Thirty-four patients underwent external fixation and for 29 patients the external fixation was a bridge to definitive fixation. The mean total hospital length of stay of all patients was 7.04 (±6.58) days.
Multivariate regression analysis demonstrated that the use of external fixation (p < .001) and the postoperative discharge destination (p < .001) were independently associated with a prolonged hospital stay.
Study authors included Quan Dang, M.D., H. Alexander Leijdesdorff, M.D., Jochem M. Hoogendoom, M.D., Ph.D., and Benjamin L. Emmink, M.D., Ph.D., all of the Haaglanden Medical Centre, the Hague, the Netherlands.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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