Delayed admission of patients with hip fracture from the emergency department is associated with an increased mortality risk and increased length of hospital stay.

Abstract

Background: The aims of this study were to assess whether delayed admission from the ED influenced mortality risk, length of acute hospital stay, risk of developing delirium and return to domicile for patients presenting with a hip fracture.

Methods: A single centre service evaluation was undertaken including patients aged over 50 years who were admitted to a Scottish hospital through the ED with a hip fracture during a 42-month period (from January 2019 to June 2022). Delay was defined as spending >4 hours in the ED from arrival. Patient demographics and perioperative variables and mortality were collected. Cox regression analysis (adjusting for age, sex, season, socioeconomic status, American Society of Anesthesiologists grade, place of residence, fracture type, delirium and time from ward to theatre) was used to determine the independent association between delayed disposition from the ED and mortality (90 days and final follow-up) as recorded on a regional database.

Results: The cohort consisted of 3266 patients with a mean age of 81 years, of which 2359 (72.2%) were female. 1261 (38.6%) patients stayed >4 hours in ED. The median follow-up was 529 days, during which time there were 1314 (40.2%) deaths. Survival at 90 days was significantly lower (hazard ratio [HR] 0.76, 95% CI 0.63 to 0.91) for patients who stayed >4 hours (92.9%) compared with those who stayed ≤4 hours (95.7%). Delayed disposition was independently associated with an increased mortality risk at 90 days (adjusted HR 1.36, 95% CI 1.12 to 1.63, p=0.001) and at final follow-up (adjusted HR 1.15, 95% CI 1.03 to 1.29, p=0.017). Delay was also associated with a longer length of hospital stay (difference in medians of 1 day, p<0.001). There were no differences in the risk of delirium on the ward (p=0.256) or return to place of residence (p≥0.315).

Conclusion: Delayed disposition from our ED was associated with an increased mortality risk and longer length of hospital stay in patients presenting with a hip fracture.