Exploring Length of Stay in Native and Periprosthetic Hip Fractures in a Newly Established Ortho-Geriatric Co-Management Service: Male Sex and Delirium Matter

Why It Matters

Identifying male sex and delirium as drivers of prolonged LOS helps hospitals refine care pathways, potentially reducing costs and improving patient outcomes in orthogeriatric settings.

Key Takeaways

• No LOS difference between native and periprosthetic hip fractures.
• Male patients stay longer than female patients.
• Admission delirium reduces discharge hazard, extending LOS.
• Frailty index, poverty level, and fall history not linked to LOS.
• Targeted interventions could shorten stays for men and delirious patients.

Pulse Analysis

Orthogeriatric co‑management services have become a cornerstone of modern trauma care, aiming to streamline recovery and curb the high costs associated with prolonged hospitalizations. Length of stay (LOS) serves as a key performance metric, influencing reimbursement, bed availability, and overall patient experience. By integrating geriatric expertise with orthopedic surgery, hospitals hope to address the complex medical needs of older adults, whose comorbidities often extend recovery timelines.

The recent study of 328 hip fracture admissions reveals nuanced insights. While the type of fracture—native versus periprosthetic—did not materially affect LOS, two patient characteristics did. Men stayed, on average, a day longer than women, and those admitted with delirium faced a 28% lower hazard of discharge, translating into extended stays. Notably, traditional risk markers such as frailty scores, socioeconomic status, and prior fall history failed to predict LOS in this co‑managed cohort, suggesting that the integrated care model may mitigate some expected disparities.

For health systems, these findings highlight actionable targets. Implementing early delirium screening and gender‑specific care protocols could trim unnecessary days, freeing capacity and reducing expenses. Moreover, the lack of LOS variance between fracture types supports the scalability of orthogeriatric programs across diverse orthopedic populations. Future research should explore tailored interventions—such as delirium prevention bundles and male‑focused rehabilitation—to further optimize throughput while maintaining high-quality outcomes.