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

Background: Hip fracture is a common injury in older people, especially those with weak bone contracture such as in osteoporosis. Although early surgical treatment is recommended, the optimal timing has not yet been determined in Japan. Therefore, we ascertained the rate of early surgery among hip fracture patients and investigated its effectiveness, along with regional clinical pathways, in reducing the length of postoperative hospital stay among patients with hip fractures. We used the Japanese Diagnosis Procedure Combination (DPC) database to obtain data for this study. Methods: We used data of patients diagnosed with femoral neck and peritrochanteric fractures retrieved from the Japanese DPC database between April 2016 and March 2018. Patients were divided into the early surgery (43,928 [34%] patients who underwent surgery within two days of admission) and delayed surgery groups (84,237 [66%] patients who underwent surgery after two days of admission). Results: The difference between the length of stay (LOS) in the hospital for both groups was two days (early vs. delayed: 21 days vs. 23 days). The early surgery group had more cases of intertrochanteric fractures (57% vs. 43%) and internal fixation (74% vs. 55%) than the delayed surgery group. In contrast, the delayed surgery group had more cases of femoral neck fractures (43% vs. 57%) and bipolar hip arthroplasty (25% vs. 42%) or total hip arthroplasty (1.2% vs. 3.0%). Moreover, the early surgery group showed a lower incidence of complications, except anaemia (12 % vs. 8.8%), than the delayed surgery group. Logistic regression analysis using the adjusted model 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.