Decreased length of hospital stay for hip fracture was associated with reduced rates of early mortality, according to a cohort study of 188,208 patients aged ≥50 years and admitted to hospital for hip fracture in New York state from 2000 to 2011. Patients received surgical or non-surgical treatment. The study determined:

• Hospital stays of 11-14 days for hip fracture were associated with a 32% increased odds of death at 30 days after hospital discharge vs stays lasting 1 to 5 days (OR, 1.32).

• These odds increased to 103% for stays >14 days. (OR, 2.03).

• Non-surgical treatment of hip fractures was associated with 10.7% mortality vs 4.5% treated surgically at 30 days after discharge.

• Additional risk factors associated with early mortality included discharge to a hospice facility, older age, metastatic disease, and non-surgical management.

Citation: Nikkel LE, Kates SL, Schreck M, Maceroli M, Mahmood B, Elfar JC. Length of hospital stay after hip fracture and risk of early mortality after discharge in New York State: retrospective cohort study. BMJ 2015;351:h6246. doi: 10.1136/bmj.h6246.

Commentary: At face value this study appears to support getting patients who have had a hip fracture out of the hospital as early as possible. The reason for patients doing better with shorter lengths of stay could be a decrease in iatrogenic infections as well as a shorter time to initiation of activity and therefore a decrease in complications such as DVT and depression. In fact, it is hard to interpret the results of this study. Shorter length of stay may simply be a surrogate marker for patients who had a lower burden of comorbidities when they sustained their hip fracture, i.e., patients who are healthier when they get a hip fracture do better than those who are not as healthy and tend to stay in the hospital for less time. Whichever the case may be, given decreasing lengths of stay, it is reassuring that complications did not systematically increase with shorter lengths of stay. —Neil Skolnik, MD