Early surgical treatment using regional clinical pathways reduces the length of postoperative hospitalization in hip fracture patients: Retrospective analysis using the Japanese Diagnosis Procedure Combination database

Background: Hip fracture is a common injury in elderly people, especially those with weak bone contracture, such as in osteoporosis. Although early surgical treatment is recommended, the optimal timing for hip fracture surgery has not been determined in Japan. To date, regional clinical pathways have been introduced into the clinical field to treat patients in a more effective and unified manner. In this study, we aimed to determine the rate of early surgery among hip fracture patients and the effectiveness of early surgery and the implementation of regional clinical pathways in reducing the length of postoperative hospital stay in hip fracture patients using Japanese Diagnosis Procedure Combination (DPC) database. Methods: : Data of patients diagnosed with femoral neck and femoral peritrochanteric fractures retrieved from the Japanese DPC database between April 2016 and March 2018 were used. Patients were divided into early surgery group (43,928 [34%] patients, surgery within 2 days of admission) and delayed surgery group (84,237 [66%] patients, surgery after 2 days of admission). Results: : The difference in length of stay (LOS) between the early and delayed surgery groups was 2 days (early vs. delayed: 21.00 days vs. 23.00 days). The early surgery group had more cases of intertrochanteric fractures (57.4% vs. 43.4%) and internal fixation (74.3% vs. 55.4%) than the delayed surgery group. In contrast, the delayed surgery group had more cases of femoral neck fractures (42.6% vs. 56.6%) and bipolar hip arthroplasty (24.5% vs. 41.6%) or total hip arthroplasty (1.2% vs. 3.0%). The early surgery group showed a lower incidence of complications, except anemia (12.0% vs. 8.8%), than the delayed surgery group. Multilevel regression analysis showed that early surgery and implementation of regional clinical pathways reduced LOS by 2.58 and 8.06 days, respectively (p < 0.001). Conclusions: : Early surgery was performed in a third of all hip fracture patients. Early surgery and implementation of regional clinical pathways for hip fracture patients are effective in reducing postoperative hospital LOS, with regional clinical pathways having a greater impact. These findings will help acute care providers when treating patients with hip fractures.