Electronic Medical Record Data-Based Analysis of Discharge Pathways and Functional Recovery by Surgical Procedure...

Background and Objectives: Discharge planning after hip-related fracture surgery may depend on both the surgical method and functional recovery achieved during convalescent rehabilitation. This single-center retrospective cohort study aimed to determine whether discharge pathways differed according to surgical procedure and whether functional recovery patterns differed according to surgical procedure and discharge pathways among patients admitted for convalescent rehabilitation after hip-related fracture surgery. Materials and Methods: This retrospective cohort study reviewed the EMRs of patients admitted to a convalescent rehabilitation hospital between January 2021 and June 2025 after hip-related fracture surgery. Surgical groups were hip hemiarthroplasty (HA), total hip arthroplasty (THA), and internal fixation (IF). Discharge pathways were classified into three categories: home discharge, transfer to an acute-care hospital, and transfer to a long-term care hospital. In this study, home discharge was operationally defined as discharge to the patient's home or transfer to a nursing hospital. Functional outcomes included the functional ambulation category (FAC), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE); complete-case analysis was applied for functional outcomes. Results: In the overall postoperative cohort (N = 445), discharge pathway distributions differed across surgical groups. In the complete-case traumatic hip-related fracture cohort (N = 243), all groups showed significant improvements from admission to discharge in FAC, BBS, MBI, and MMSE. Between-group comparisons of change scores by surgical method were generally modest. In contrast, discharge pathways showed clearer associations with recovery. Patients achieving home discharge demonstrated greater improvements in FAC, BBS, and MBI measures than those transferred to acute care or nursing homes. Conclusions: Functional recovery was observed across all surgical groups during convalescent rehabilitation. Discharge disposition appeared to be more closely associated with recovery in gait, balance, and ADL performance than with surgical method alone; however, this finding should be interpreted cautiously because discharge decisions may also be influenced by patient and social factors.