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Effect of an Integrated Postdischarge Care Program for Older Patients After Hip Fracture Discharged to the Community:
Jonas Ammundsen Ipsen1, Donna Lykke Wolff2, Maria Klitgaard Christensen3
1Research Center for Integrated Healthcare, Region of Southern Denmark, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Orthopaedic Research Unit, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Clinical Institute, University of Southern Denmark, Odense, Denmark.
Objectives:
To assess 30-day mortality, readmissions, and cost-effectiveness following implementation of a new postsurgical care pathway compared with usual care after hip fracture.
Design:
Prospective multicenter cohort study (January 2022-June 2025). The intervention was implemented from November 2023.
Setting And Participants:
The study was conducted across 3 hospitals and 18 municipalities in the Region of Southern Denmark. A total of 2609 patients aged ≥65 years undergoing hip fracture surgery were included (mean age, 82 years; 67% female). Of these, 524 received the intervention and 2085 received usual care.
Methods:
The intervention consisted of a 14-day postdischarge period with structured safety monitoring (vital signs, mobilization, and pain), mandatory municipal nurse follow-up visits, and the option for nurse-hospital consultation to support at-home management. The primary outcome was 30-day mortality. Secondary outcomes included 30-day readmission, mean 3-month costs, number needed to treat, and incremental cost per saved life. Analysis was preplanned, and average treatment effects were estimated using targeted maximum likelihood estimation for mortality G-computations for readmission.
Results:
Thirty-day mortality decreased from 11.9% to 8.0% in the intervention group (odds ratio, 0.60; 95% CI, 0.37-0.85), corresponding to a number needed to treat of 19. Readmissions increased (18.6% vs 13.6%; risk ratio, 1.28; 95% CI, 1.05-1.56). Mean 3-month costs were €1079 higher in the intervention group (95% CI, €395-€1767). The incremental cost per life saved was €21,590.
Conclusions And Implications:
Implementation of a structured postsurgical care pathway reduced early mortality after hip fracture and was cost-effective according to international thresholds, despite increased readmissions. These findings support the adoption of coordinated postdischarge care pathways in clinical practice and health systems. Future research should examine mechanisms underlying increased readmissions and assess long-term outcomes and cost-effectiveness.
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