[Cost and mortality associated to the surgical delay of patients with a hip fracture. Spain]

Abstract

Background: Hip fractures surgery is often delayed for several days. The present work has two objectives. The first one is to determine the preoperative hospital length of stay of patients with a hip fracture in our region and its possible correlation with an increase in mortality rate. Secondly we assessed the healthcare expenditure associated to this preoperative period.

Methods: We carried out an observational, retrospective study in which all hip fractures attended in the Basque Country throughout 2010 were assessed by the Minimun Basic Data Set (MSBD): hospital, age, sex, preoperative hospital length, status at hospital discharge, comorbidities and surgical procedure. Furthermore we studied the Charlson Index and the total cost associated stratified by pre and post-operative period using a multiple model regression.

Results: A total of 1856 surgical procedures were analyzed. Average pre and post-operative length of stay was 2.7 and 9.7 days respectively. The mean total cost per hospital admission was 12,552 € with 1,295.5 € corresponding to the preoperative period. The duration of preoperative stay is not associated with a significant reduction in mortality, although it did with an increase in the total cost.

Conclusions: Preoperative hospital stay in patients with hip fracture is still challenging. We could not find an association between the delays in surgical procedures and hospital mortality, although it seems to be associated with an increased the total procedure cost. These results can serve as a foundation for setting up strategies to decrease the length of hospital stay, not only for cost-saving purposes.