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Predictors of Hospice Discharge After Surgical Fixation of Hip Fractures
Kevin L Mekkawy1, Yash P Chaudhry, Sandesh S Rao
1From the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Mekkawy, and Barry), Washington Orthopaedics & Sports Medicine, Washington, DC (Rao), University of Rochester Medical Center, Rochester, NY (Puvanesarajah), the Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA (Chaudhry), and the Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA (Amin).
Background:
Each year, over 300,000 people older than 65 years are hospitalized for hip fractures. Given the notable morbidity and mortality faced by elderly patients in the postinjury period, recommendations have been put forth for integrating palliative and, when needed, hospice care to improve patients' quality of life. Our objective was to (1) understand the proportion of patients discharged to hospice after hip fracture surgery and their 30-day mortality rates and (2) identify the independent predictors of discharge to hospice.
Methods:
We retrospectively queried the American College of Surgeons National Surgical Quality Improvement Program for all hip fracture surgeries between the years of 2016 and 2018. Included cases were stratified into two cohorts: cases involving a discharge to hospice and nonhospice discharge. Variables assessed included patient demographics, comorbidities, perioperative characteristics, and postoperative outcomes. Differences between hospice and nonhospice patients were compared using chi-squared analysis or the Fisher exact test for categorical variables and Student t -tests for continuous variables. A binary logistic regression model was used to assess independent predictors of hospice discharge with 30-day mortality.
Results:
Overall, 31,531 surgically treated hip fractures were identified, of which only 281 (0.9%) involved a discharge to hospice. Patients discharged to hospice had a 67% 30-day mortality rate in comparison with 5.6% of patients not discharged to hospice ( P < 0.001). Disseminated cancer, dependent functional status, >10% weight loss over 6 months preoperatively, and preoperative cognitive deficit were the strongest predictors of hospice discharge with 30-day mortality after hip fracture surgery.
Conclusions:
Current hospice utilization in hip fracture patients remains low, but 30-day mortality in these patients is high. An awareness of the associations between patient characteristics and discharge to hospice with 30-day mortality is important for surgeons to consider when discussing postoperative expectations and outcomes with these patients.
Level Of Evidence:
Level III, retrospective comparative study.
