Determinants of hospital length of stay in older adults after hip fracture: a prospective cohort study

To investigate factors associated with hospitalization length in older adults after hip fracture surgery. Prospective observational cohort study. A total of 172 older adults (mean age 79.01 ± 8.66 years; 70.30% women) hospitalized for fragility hip fractures. Data were collected within the first 24 hours post-surgery. Hospitalization length (in days). Factors investigated for the association with length of stay included sociodemographic, surgical, and laboratory variables, as well as multimorbidity, polypharmacy, self report of pain, cognitive, emotional, nutritional, and functional status. A generalized linear model adjusted for age and sex was used, with a significance level of 5% (p ≤ 0.05). The mean hospitalization length was 5.4 days. Cognitive impairment was observed in 86.9% of participants, depressive symptoms in 63.6%, and 68.8% were at risk of malnutrition. Mean handgrip strength was 18.48 kg. Generalized linear model analysis indicated that a longer interval (in days) from fracture to surgery, delayed surgery, higher ferritin and urea levels, lower Cumulated Ambulation Score (CAS). and lower handgrip strength were associated with longer hospitalization (p < 0.05). A longer fracture-to-surgery interval (including delayed surgery), higher urea and ferritin levels, and poorer early functional status (lower CAS and reduced handgrip strength) were independently associated with a longer hospital stay among older adults with hip fracture. These findings support hospital strategies to minimize surgical delays, monitor renal-related and inflammatory markers, and incorporate early functional assessments to identify patients at risk of prolonged hospitalization. Addressing system-level contributors to surgical delay (e.g., access barriers, transportation, bed availability) may also improve the continuum of care.