Overview
Marinella and Markert identified predictors for a prolonged hospital stay following surgery to repair a fall-related fractured hip. These can help to identify a patient who may benefit from more aggressive management. The authors are from Wright State University in Dayton, Ohio.
Patient selection: elderly adult with a fall-related hip fracture
Predictors of prolonged hospital stay:
(1) thrombocytopenia on admission
(2) total hip arthroplasty
(3) postoperative respiratory failure
(4) postoperative infection
(5) postoperative cardiac complication
(6) postoperative delirium
These were used to develop a clinical score.
Parameter |
Finding |
Points |
platelet count on admission |
normal or elevated |
0 |
|
thrombocytopenia |
1 |
total hip arthroplasty |
not done |
0 |
|
done |
1.5 |
postoperative respiratory failure |
absent |
0 |
|
present |
4 |
postoperative infection |
absent |
0 |
|
present |
2 |
postoperative cardiac complication |
absent |
0 |
|
present |
1.5 |
postoperative delirum |
absent |
0 |
|
present |
1 |
where:
• Many hip fractures in the elderly are related to osteopenia or osteoporosis.
• Most hip fractures in the elderly involve the femoral head or neck. The need to perform a total hip arthroplasty raises the possibility of a combined femoral-acetabular fracture.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the more likely that the patient will have a prolonged hospital stay.
Limitations:
• The length of stay for an individual patient cannot be predicted (page 456).
Additional factors to consider:
(1) low serum albumin or other sign of poor nutrition
(2) severity of osteoporosis
Specialty: Surgery, orthopedic