Abstract
ObjectiveTo investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery. DesignRetrospective cohort study. Setting and ParticipantsData from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included. MethodsPatients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors. ResultsHigher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively. Conclusions and ImplicationsThis study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL.
Highlights
From 2017 to 2019 a total of 31,802 patients, with an age of 70 years or older and who had hip fracture surgery, were registered in the Dutch Hip Fracture Audit (DHFA) database. From those patients 10,626 patients were excluded owing to not living at home prior to the hip fracture, in-hospital mortality, or an unknown discharge destination
Higher age [odds ratio (OR)1⁄41.1, 95% confidence interval (CI) 1.1-1.1], being mobile with aids or indoor confined prior to the hip fracture vs fully mobile (OR1⁄41.8, 95% CI 1.6-1.9, and OR1⁄41.7, 95% CI 1.4-1.9, respectively), lower premorbid Katz-activities of daily living (ADL) (OR1⁄41/0.91⁄41.1, 95% CI 1.1-1.3), no history of dementia vs history of dementia (OR1⁄42.0, 95% CI 1.8-2.2), ASA score of 3 to 5 vs ASA score of 1 or 2 (OR1⁄41.4, 95% CI 1.3-1.5), general anesthesia vs spinal anesthesia (OR1⁄41.1, 95% CI 1.1-1.2), intramedullary implant vs hemiarthroplasty (OR1⁄41.5, 95% CI 1.4-1.6), and cotreatment by a geriatrician vs no cotreatment (OR1⁄41.4, 95% CI 1.3-1.6) were independent predictors of discharge to geriatric rehabilitation vs discharge home (Table 3A)
Results of this study showed that age, Pre-Fracture Mobility Score (PFMS), premorbid Katz-ADL, history of dementia, ASA score, type of anesthesia, surgical treatment, and cotreatment by a geriatrician were independent predictors for discharge to a geriatric rehabilitation department vs discharge home
Summary
Data from patients with hip fracture aged 70 years or older who were registered in the DHFA database between January 1, 2017, and December 31, 2019, were used in this study. The DHFA database included demographic information, in-hospital information, and follow-up information after 3 months and 1 year. Inclusion criteria for this study were living at home prior to the hip fracture with or without help; this included patients who lived at a residential home. Exclusion criteria were in-hospital mortality and an unknown discharge destination. Patients with periprosthetic or pathologic fractures are already excluded by the DHFA. Patients are categorized into 3 groups regarding the discharge destination: home environment (home group), geriatric rehabilitation department (rehabilitation group), and nursing home for long-term care (nursing home group)
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