Hip fracture: a prospective study of hospital course, complications, and costs.

A prospective study of 79 patients with recent hip fracture revealed prior functional impairments with community mobility (49%), using a bathtub (40%), walking outdoors (26%), and stair-climbing (18%). Eighty-six per cent of patients (mean age 77.9 years) were admitted from home, with 95% surviving to discharge but only 28% returning directly home following surgical repair. In-hospital complications included confusion (49%), urinary tract infection (33%), and heart rhythm disturbance (26%). Mean length of stay was 21.7 days and mean hospital charges were $11,052. The outliers (15%) averaged 60.6 days in length of stay and $28,190 in charges. Stepwise multivariate regression revealed that lengths of stay varied significantly with prefracture functional status, presence of intertrochanteric fractures, and in-hospital complications, but not with patient age. Examination of these findings in relation to prospective reimbursement led to the conclusion that hip fracture patients are particularly vulnerable in the era of new hospital strategies to avoid high-cost patients and curtail hospital costs.