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Home discharge location is safest following fracture of the hip
Alexa R Deemer1, Abhishek Ganta1,2, Philipp Leucht1
1NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, USA.
Insights
Hip fracture patients discharged home had better baseline health and function, leading to fewer complications and readmissions. Marital status and assistive device use were key factors influencing home discharge.
Area of Science:
- Orthopedic Surgery
- Geriatric Medicine
- Health Services Research
Background:
- Hip fractures are a significant health concern, particularly in the elderly population.
- Discharge disposition after hip fracture surgery impacts patient outcomes and healthcare resource utilization.
Purpose of the Study:
- To identify factors associated with discharge location in hip fracture patients.
- To evaluate if home discharge is linked to reduced readmission and complication rates.
Main Methods:
- Retrospective analysis of hip fracture patients undergoing operative management.
- Data collected included demographics, injury details, and discharge disposition (home, acute rehabilitation facility [ARF], or sub-acute rehabilitation facility [SAR]).
- Statistical analysis to determine factors associated with home discharge and its impact on outcomes.
Main Results:
- Patients discharged home were more likely to be married and less likely to require assistive devices.
- Home discharge was associated with significantly lower rates of post-operative complications and hospital readmissions.
- Factors decreasing odds of home discharge included Medicare/Medicaid enrollment, assistive device use, higher Charlson Comorbidity Index (CCI), and more inpatient complications.
Conclusions:
- Hip fracture patients discharged to home generally presented with better baseline health and functional status.
- Home discharge is associated with favorable outcomes, including reduced readmission and complication rates.
- Patient's marital status, functional status (assistive device use), insurance, comorbidities, and hospital course complexity influence discharge destination.
Purpose:
To determine the factors associated with discharge location in patients with hip fractures and whether home discharge was associated with a lower readmission and complication rate.
Methods:
Hip fracture patients who presented to our academic medical center for operative management of a hip fracture were enrolled into an IRB-approved hip fracture database. Radiographs, demographics, and injury details were recorded at the time of presentation. Patients were grouped based upon discharge disposition: home (with or without home services), acute rehabilitation facility (ARF), or sub-acute rehabilitation facility (SAR).
Results:
The cohorts differed in marital status, with a greater proportion of patients discharged to home being married (51.7% vs. 43.8% vs. 34.1%) (P < 0.05). Patients discharged to home were less likely to require an assistive device (P < 0.05). Patients discharged to home experienced fewer post-operative complications (P < 0.05) and had lower readmission rates (P < 0.05). Being married was associated with an increased likelihood of discharge to home (OR = 1.679, CI = 1.391-2.028, P < 0.001). Being enrolled in Medicare/Medicaid was associated with decreased odds of discharge to home (OR = 0.563, CI = 0.457-0.693, P < 0.001). Use of an assistive device was associated with decreased odds of discharge to home (OR = 0.398, CI = 0.326-0.468, P < 0.001). Increases in CCI (OR = 0.903, CI = 0.846-0.964, P = 0.002) and number of inpatient complications (OR = 0.708, CI = 0.532-0.943, P = 0.018) were associated with decreased odds of home discharge.
Conclusion:
Hip fracture patients discharged to home were healthier and more functional at baseline, and also less likely to have had a complicated hospital course. Those discharged to home also had lower rates of readmission and post-operative complications.
Level Of Evidence:
III.
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