Shorter hospital stay for hip fracture associated with increased odds of survival

The longer a hip fracture patient stays in a hospital, the more likely that patient will die within 30 days of leaving, according to a study led by Stephen Kates, M.D., chair of the Department of Orthopaedic Surgery at the Virginia Commonwealth University School of Medicine.

The study, published in a December 2015 issue of the British Medical Journal, refuted conclusions from a February 2015 BMJ article that had reported that longer hospital stays lead to increased odds of survival following hip fracture. The original study, which was published by a research team from Sweden, found that Swedish patients who spend less time at the hospital are more likely to die after they leave compared with those who stay longer at the hospital.

"The Swedish study said that the longer the patient stays in the hospital, the better," Kates said. "I felt that was a harmful finding to transmit to the medical public in the U.S."

There are about 340,000 hip fractures in the U.S. in a year, with the majority of patients between the ages of 81 to 85 years old. The research team from the University of Rochester, where Kates served as a Hansörg Wyss Professor of Orthopaedic Surgery before joining VCU in November, looked at a sampling of more than 188,000 patients admitted to hospitals for hip fracture in the state of New York from 2000 to 2011. Researchers found that hospital stays of 11 to 14 days for hip fracture were associated with a 32 percent increased odds of death 30 days after discharge, compared with stays lasting one to five days. The odds of death increased to 103 percent for stays longer than 14 days.

"The results showed that the shorter you stayed in the hospital in the United States, the better," Kates said. "It clearly was the opposite of what the Swedes had found in their country. The Swedish article may be true in Sweden, but it is not true in the United States."

The average hospital stay for a hip fracture in the U.S. is 6.3 days. In Sweden the average stay is more than 11 days. Kates says the discrepancy may be due to care received after leaving the hospital. More than 90 percent of patients in the U.S. go from the hospital to a skilled nursing facility where patients receive supervised care from a medical professional. In Sweden, patients usually return directly home.

"This study validates the trends toward shorter stays in the U.S. as being the right thing to do," Kates said.