Comparison of length of stay after isolated femoral and tibial shaft fractures at two level 1 trauma centers

Abstract

Background: A reliable predictor of costs after trauma is hospital length of stay (LOS). This study sought to determine if differences exist in LOS after closed and isolated femoral and tibial shaft fractures between two level 1 trauma centers and to determine patient and hospital factors affecting LOS. Methods: Trauma registries at two centers from 2006 to 2011 were reviewed to identify eligible patients. The centers were an academic inner city hospital (HA) and a large community hospital (HB) in a major metropolitan area. Retrospective chart review identified variables of interest. Results: Ninety-nine patients met the inclusion criteria: 32 femoral fractures and 30 tibial fractures at HA, and 19 femoral fractures and 18 tibial fractures at HB. The average LOS after femoral fracture was 1.8 days shorter in HA than HB, and LOS after tibial fracture at HA was 2.3 days shorter than at HB (P<0.05). Time from admission to surgery was significantly shorter at HA. Time from admission to surgery greater than 1 day was associated with significantly longer LOS. Patient-controlled analgesia for longer than 2 days also was correlated with significantly longer stays. Patients remaining on general trauma service after orthopaedic intervention at HB stayed 1.5 days longer than those on the orthopaedic service (P>0.05). Differences in patient medical history between hospitals were not significant. Conclusions: Patients with identical injuries stayed significantly longer at HB than at HA. Standardizing discharge qualifications across hospital services, reducing time from admission to surgery delays with dedicated trauma operating room and adequate ancillary staff, and transitioning promptly from patient-controlled analgesia use may reduce LOS.