Analysis Of The Related Factors Of Prolonged The Length Of Stay After Total Hip Arthroplasty Surgical Treatment For Elderly Hip Fracture

Objective:To analyze the related factors of prolonged the length of stay（pLOS）after Total Hip Arthroplasty（THA）surgical treatment for elderly hip fractur,and to provide quality service and scientific basis for reducing postoperative Length of Stay（LOS）and prevent postoperative pLOS.Method:Retrospective study the clinical data of elderly patients（age≥65 years）who were admitted to the Bone and Joint Orthopedics Center of the First Affiliated Hospital of Nanchang University from January 2017 to December 2019 due to hip fractures and were treated by THA.According to LOS≥75th postoperative LOS,they were divided into postoperative LOS normal group（LOS<75th postoperative LOS）and postoperative LOS prolonged group（LOS≥75th postoperative LOS）.Record the basic preoperative information of the patient:including gender,age,place of residence,fracture type,self-care status,body mass index（Body Mass Index,BMI）;preoperative data:including anemia and hypoalbuminemia in preoperative,waiting time before surgery,American Society of Anesthesiologists（ASA）grade;perioperative data:including operation time,estimated blood loss in intraoperative,anemia and hypoalbuminemia in postoperative,at bed time in postoperative,adverse events.These factors that may affect postoperative pLOS of patients were analyzed by univariate analysis,and the relevant factors of postoperative pLOS were screened as independent variables.The normal group and the prolonged group were used as dependent variables for binary logistic regression analysis to establish the relevant factors of postoperative pLOS.Result:A total of 405 patients with hip fractures met the inclusion criteria and were analyzed.Including 127 males,accounting for 31.4%,and 278 females,accounting for 68.5%.The patients were 65 to 94 years old,the average age was（76.6±6.8）years,the postoperative LOS was 3～40 days,and the average postoperative LOS was（9.6±4.3）days.The postoperative LOS≥75^th was 12 days,290patients normal postoperative LOS,accounting for 71.6%,another 115 patients postoperative p LOS,accounting for 28.4%.According to the binary logistic regression analysis,BMI<18.5kg/m²（P=0.022）,ASA grade 3 and 4（P=0.042）,hypoalbuminemia in postoperative（P=0.01）,at bed time 4～5 days in postoperative（P<0.001）,at bed time 6 days or more（P<0.001）,and adverse events in postoperative（P<0.001）are related factors affecting pLOS after THA surgical treatment for hip fractures of elderly patients.The BMI<18.5kg/m² was 2.261 times of the normal,the postoperative pLOS of patients with ASA grade 3 and 4 was 4.741 times that of ASA grade 1,the hypoalbuminemia occurred pLOS is 2.177 times that of no hypoalbuminemia at postoperative;bed time 4～5 days is 5.208 times that of bed time≤3 days at postoperative;bed time 6 days or more is 5.208 times that of bed time≤3days at postoperative;Adverse events is 6.847 times that without adverse events at postoperative.Conclusion:BMI<18.5kg/m²,ASA grade 3 and 4,hypoalbuminemia at postoperative,at bed time≥4 days,and adverse events at postoperative are related factors affecting the postoperative pLOS after THA surgical treatment for elderly hip fracture.Our surgeons should pay attention to patients with preoperative BMI<18.5kg/m² and ASA grades 3 and 4,and promptly correct hypoproteinemia after surgery,encourage early getting out of bed after surgery,and prevent adverse events after surgery will shortene postoperative LOS.