Length of Hospitalization: A Protective Factor in a Prospective Observational Cohort Study in Brazilian ASA III and IV Hip Fracture Elderly Patients

Abstract

Background: Hip fracture is a devastating injury in elderly and the vast majorities are usually treated surgically. However, this treatment can also be non-operative, principally for patients classified at ASA III-IV. Several risk factors are associated with 1-year mortality for operated patients but a small number of studies provide the risk factors for non-operated patients. The aim of this study was to investigate the influence of hospitalization time and other risk factors on non-operated patients. Methods: A prospective observational cohort study from April 2005 to April 2012 was conducted on 286 patients aged 65 years or more with hip fracture classified at ASA III-IV for 1 year to investigate the influence of hospitalization time and the 1-year mortality risk factors. Survival time was analyzed by Kaplan-Meier curves and Cox’s regression models were used to evaluate risk factors to all subjects, operated and non-operated subjects. Results: The mortality was 73.5% for non-operated subjects. Final Cox’s regression for all subjects demonstrated that for patients that do not undergo surgery, mortality increased by six times. To operated patients, for each day of hospitalization, 1-year survival decreased 12.6 days, and ASA IV increased the mortality rate three times. To non-operated subjects, hospitalization time was a protective factor; for each day of hospitalization, 1-year survival increased 10.44 days. Conclusion: When conservative treatment is chosen for a complicated elderly, extended hospitalization should be considered. Hospitalization time has proved to be a protective factor in these cases and discharge with improved survival rates with good clinical status should be advocated. However, surgery should always be employed even for patients with poor clinical conditions. J Curr Surg. 2016;6(1):21-29 doi: http://dx.doi.org/10.14740/jcs296e