Factors for Increased Hospital Stay and Utilization of Post -Acute Care Facilities in Geriatric Orthopaedic Fracture Patients.

Abstract

This study aims to determine the extent of utilization of health care resources in the geriatric fracture population and to identify factors associated with burden on resources. This is a retrospective study of 1074 patients ≥65 years admitted to an orthopaedic service for a long bone fracture between July 2014 - June 2015. Outcomes were hospital length of stay (LOS), discharge disposition, and post-acute care facility LOS. Secondarily, readmission rates and mortality were assessed. Multivariable regression was performed to identify factors associated with utilization. Prior to injury, 96% of patients lived at home and 50% ambulated independently. Median hospital LOS was 5 days (IQR 3 - 7). 878 patients were discharged to a rehabilitation facility, with 45% being discharged <20 days. Ten percent of patients (n = 108) were re-admitted <90 days of their discharge. 924 patients were still alive one year after the injury. Higher Charlson Comorbidity Index (CCI) (P=0.048), male sex (P<0.001), pre-injury use of an ambulatory device (P = 0.006), and undergoing surgical treatment (P<0.001) were associated with longer hospital LOS. Older age (P<0.001), pre-injury ambulatory device (P=0.001), and surgery (P=0.012) were risk factors for requiring discharge to another inpatient facility. Older age (P<0.001), pre-injury ambulatory aid (P<0.001), and pre-existing immobility (P<0.001) were independent risk factors for LOS >20 days in a rehabilitation facility. Discharge home was not found to be associated with an increase in 1-year mortality after adjusting for age, CCI, sex, fracture location, and surgery (P=0.727). Shorter LOS in rehabilitation facilities (<20 days) was also not associated with an increase in 1-year mortality (P=0.520). Elderly fracture patients utilize a significant amount of post-acute care resources and age, CCI, surgery, fracture location, pre-injury ambulatory status, and pre-injury living status were found to be associated with the use of these resources.