Association between multimorbidity and length of hospital stay among elderly patients with femoral neck fractures based on propensity scores

LI Pei-pei; ZHANG Zi-ruo; ZHI Hong; CHEN Dan; WEN Lian; HU Jing

doi:10.3969/j.issn.2095-252X.2025.12.007

Abstract：Objective To analyze the effect of chronic co-morbidities on the length of hospital stay of elderly patients with femoral neck fracture and control the confounding factors by propensity score matching method to provide scientific basis for optimizing the perioperative management and shortening the length of hospital stay.Methods A retrospective cohort study was conducted on elderly patients with femoral neck fractures admitted to Honghui Hospital,Xi'an Jiaotong University,between January 1st,2021,and January 1st,2022.After applying exclusion criteria,1,091 patients were included and stratified into two groups:comorbidity group(476 patients)and non-comorbidity group(615 patients),based on the presence of two comorbid chronic diseases.Propensity score matching(PSM)with a caliper width of 0.05 was performed in a 1:1 ratio,resulting in 258 matched pairs(516 patients).Demographic and clinical data,laboratory parameters,and surgical variables were collected.Univariate and multivariate logistic regression analyses were used to identify factors associated with prolonged hospital stay(>9 days).The relationship between multimorbidity and prolonged hospital stay was further determined by multi-model regression strategy and stratified analysis.Results In 1091 patients,the incidence of prolonged hospital stay was 30.8%(336 patients).The incidence of prolonged hospital stay was significantly higher in the comorbidity group than in the non-comorbidity group(39.7%vs.23.9%,P<0.001).After PSM,univariate analysis showed that hemiarthroplasty had a higher risk of prolonged hospitalization than total hip arthroplasty(OR=1.74,95%CI:1.07-2.83,P=0.026).Hemoglobin(OR=0.99,95%CI:0.98-0.99,P=0.044)and serum albumin(OR=0.93,95%CI:0.89-0.98,P=0.004)were the protective factors.After PSM,multivariate results showed that multimorbidity was an independent risk factor for prolonged hospitalization in elderly femoral neck fractures(OR=1.58,95%CI:1.08-2.33,P=0.019);the multimodel regression strategy and stratification analysis further determined that multimorbidity patients had a higher risk of prolonged hospitalization than non-multimorbidity patients(P<0.05).Conclusions Multimorbidity significantly increases the risk of prolonged hospital stay in elderly patients with femoral neck fractures,which is further exacerbated by Semi-hip replacement,while higher hemoglobin and albumin levels reduce the risk.It is recommended to strengthen preoperative evaluation,optimize surgical selection and nutritional management for comorbid patients to improve clinical outcomes.