POS-348 Predicting difficulties with direct home discharge following hip fracture for patients living with CKD: Insights from a 6-year prospective study

Abstract

Patients with chronic kidney disease (CKD) are at higher risk of falls and sustaining hip fractures compared to those without CKD. Worse clinical outcomes are observed in CKD groups, exacerbated by frailty, sarcopenia and other co-morbidities. Arranging discharge to own home following hip fracture is often difficult for older patients living with CKD. Patients with CKD usually have markedly deteriorated functional status following acute trauma and basic rehabilitation requirements cannot be holistically supported within a home environment. The most useful clinical assessment tool to predict for non-home discharge in patients with CKD following hospitalization with hip fracture remains unknown. Patients with CKD G3b-5 admitted from home to a tertiary hospital in North West UK with hip fracture between Jun 2013 and Dec 2019 were included. Parameters assessed on hospital admission for each patient included Clinical Frailty Scale (CFS), Charlson’s Co-morbidity Index (CCI), Chronic Kidney Disease Frailty Index Laboratory Score (CKD FI-LAB), Karnofsky Performance Status Scale, Sernbo Score, Nottingham Hip Fracture Score, Estimated VO2 Peak, ASA Physical Status Classification System Score and Abbreviated Mental Test Score. Patients who did not directly return home after hospitalization following hip fracture were discharged to a residential home, nursing home, specialist rehabilitation unit in the region or another district general hospital for ongoing rehabilitation needs. Receiver Operating Characteristic (ROC) curve analyses were performed to evaluate the ability of individual scoring tools to predict non-home discharge following hip fracture in patients with CKD admitted from home. A total of 225 patients met study inclusion criteria. The mean age was 81.6±10.1 yrs and the female:male ratio was 1.7:1. 33 patients (14.7%) were on long-term dialysis. 30-day in-hospital mortality was 5.9%. Following hip fracture hospitalization, 117 patients (52.0%) directly returned home on discharge. 13 patients (5.8%) were discharged to residential home, 51 patients (22.7%) to nursing home, 22 patients (9.8%) to a specialist rehabilitation unit in the region and 12 patients (5.3%) were repatriated to a district general hospital closer to the patient’s pre-admission residence. Difference in 1-year mortality rate between the non-home discharge cohort and those directly discharged home from hospital was +16.2% (p<0.001). Area under a curve (AUC) values from ROC analyses are shown in the table. Tabled 1PredictorAUC Value95% CIClinical Frailty Scale0.950.88-1.00Charlson's Co-morbidity Index0.920.85-0.99Chronic Kidney Disease Frailty Index Laboratory Score0.890.82-0.96Karnofsky Performance Status Scale0.850.78-0.92Sernbo Score0.840.77-0.91Nottingham Hip Fracture Score0.790.72-0.85Estimated VO2 Peak0.780.71-0.84ASA Physical Status Classification System Score0.690.62-0.75Abbreviated Mental Test Score0.660.59-0.73 Open table in a new tab Frailty and co-morbidity assessment tools (CFS, CCI and CKD FI-LAB) displayed the best predictive ability for non-home discharge following hip fracture in patients with CKD. Difficulty with direct home discharge is associated with significant mortality over the short term. Future research should explore holistic, multi-modal and multi-disciplinary interventions that aim to improve outcomes of patients with CKD at risk of extensive post-trauma rehabilitation needs.