Prognostic Factors for Prolonged Length of Stay in Hip Fracture Patients: A Retrospective Cohort Study at Mae Sot Hospital

Abstract

Background and objectives: Hip fracture in older adults is associated with substantial morbidity, mortality, and healthcare utilization. Prolonged hospital length of stay (LOS) after hip fracture surgery is clinically important because it may reflect delayed recovery, increase resource use, and be associated with poorer outcomes. However, evidence on potentially modifiable predictors of prolonged LOS in general hospitals in Thailand remains limited. This study aimed to identify prognostic factors associated with prolonged hospital LOS in elderly patients undergoing hip fracture surgery at Mae Sot Hospital. Secondary objectives were to evaluate the association of prolonged LOS with hospitalization cost and 1-year mortality. Methods: This retrospective cohort study included patients aged 60 years or older who underwent surgery for hip fracture at Mae Sot Hospital between January 2018 and December 2023. Prolonged LOS was defined as a hospital stay of more than 10 days. Demographic, clinical, perioperative, and rehabilitation-related variables were analyzed. Univariable and multivariable regression analyses were performed to identify factors associated with prolonged LOS. Additional analyses were conducted to examine the association of prolonged LOS with hospitalization cost and 1-year mortality. Results: A total of 223 patients were included. Delayed surgery of more than 3 days was independently associated with prolonged LOS, whereas early rehabilitation was associated with a reduced likelihood of prolonged LOS. Prolonged LOS was also associated with increased hospitalization cost. In univariable analysis, prolonged LOS was associated with higher 1-year mortality. Conclusions: In this general hospital setting, delayed surgery and lack of early rehabilitation were important factors associated with prolonged hospitalization after hip fracture surgery. Prolonged LOS was also associated with higher hospitalization cost and worse 1-year survival. These findings support efforts to improve early surgical access and timely postoperative rehabilitation in elderly hip fracture care.