title: Factors affecting delay to surgery and length of stay for patients with hip fracture.
abstract: OBJECTIVE
  The purpose of this study was to determine factors, including day of week of hospital admission, associated with delay to surgery (DTS) and increased length of stay (LOS) in patients with hip fractures.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Level I Trauma Center.
  
  
  METHODS
  Six hundred thirty-five consecutive patients admitted to a single hospital between January 1999 and July 2006 aged 65 years or older with a hip fracture (OTA 31) were identified retrospectively from an orthopaedic database. Demographic data, American Society of Anesthesiologists (ASA) score, hospital admission and discharge dates, the date of surgery, and details of any preoperative cardiac testing were extracted from the hospital record. These data were used to identify the day of week for hospital admission and to calculate days for DTS and hospital LOS. Linear regression was used to identify independent variables associated with DTS and increased LOS.
  
  
  METHODS
  All patients underwent surgical treatment of a hip fracture (OTA 31).
  
  
  METHODS
  Factors affecting DTS and LOS.
  
  
  RESULTS
  Independent factors associated with DTS included the day of week for hospital admission, ASA score, and the need for preoperative cardiac testing. Patients admitted Thursday through Saturday had longer DTS (mean, 2.2-2.7 days) than did patients admitted other days (mean, 1.7-1.8). DTS increased for increasing ASA: 1.4 days for ASA 2, 2.0 days for ASA 3, and 3.0 days for ASA 4. Those requiring preoperative cardiac testing had an increased number of days to surgery (mean, 3.2 days) than those without (mean, 1.7 days). Independent factors associated with increasing hospital LOS included ASA, the need for preoperative cardiac testing, male gender, and day of admission. LOS increased for increasing ASA: 6.3 days for ASA 2, 8.1 days for ASA 3, and 10.1 days for ASA 4. Those requiring preoperative cardiac testing had an increased LOS (mean, 9.4 days) than those without (mean, 7.3 days). Male patients had a longer LOS (mean, 9.8 days) than did females (mean, 7.3 days). Patients admitted on Thursday or Friday (mean, 8.5-9.1 days) had longer LOS than those admitted on other days (mean, 7.3-7.9 days).
  
  
  CONCLUSIONS
  This is the first study to consider and identify the day of admission and need for preoperative cardiac tests as determinants of DTS and LOS for geriatric patients with hip fracture. Relative scarcity of weekend hospital resources, when present, may be responsible for these delays. This study also confirms that patient medical condition as measured by ASA affects both DTS and LOS.
  
  
  METHODS
  Prognostic level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
authors.forename: William M
authors.initials: WM
authors.lastname: Ricci
authors.forename: Angel
authors.initials: A
authors.lastname: Brandt
authors.forename: Christopher
authors.initials: C
authors.lastname: McAndrew
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gardner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors