title: Factors associated with a protracted hospital stay after hip fracture surgery in Japan.
abstract: OBJECTIVE
  Hip fracture is a major injury in the elderly and has a high impact on quality of life and use of health-care resources. In this study, we aimed to identify the factors related to prolonged hospital stay and poor outcome after hip fracture surgery.
  
  
  METHODS
  We evaluated data from 8920 cases at 398 acute-care hospitals in Japan. Multivariate logistic regression analysis was used to determine the factors associated with the length of postoperative hospital stay.
  
  
  RESULTS
  A shorter postoperative hospital stay was associated with admission to a high surgical volume hospital (P<0.001). On the other hand, a longer postoperative hospital stay was associated with infective complications, admission to a private hospital, an interval of more than 3days between admission and surgery (P<0.001 for all), and an interval of more than 1day between surgery and start of rehabilitation (P=0.01). Further analysis revealed that infective complications were more likely in older patients (P=0.003) and patients with comorbidities (P=0.03).
  
  
  CONCLUSIONS
  The results imply that hospital stay, and, therefore, use of medical resources, can be decreased by performing surgeries shortly after patients are admitted, preventing postoperative infections, and starting rehabilitation on the next day of the surgery. One of the limitations of our study was that data of the length of hospital stay at transferred hospitals were not available. Therefore, further prospective studies will be needed to address significance of early surgery and rehabilitation.
authors: Health Care Informatics Section, Department of Health Policy, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors: Chihiro
authors: C
authors: Takahashi
authors: Kiyohide
authors: K
authors: Fushimi
authors: Shinya
authors: S
authors: Matsuda