Clinical Predictors of Marinella and Markert for a Prolonged Hospital Stay After Surgery for a Hip Fracture in an Elderly Patient

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