Determinants of postsurgical discharge setting for male hip fracture patients

Abstract

Abstract-Veterans hospitalized for hip fracture repair may be discharged to one of several rehabilitation settings, but it is not known what factors influence postsurgical discharge setting. The purpose of the study was to examine the patient, facility, and market factors that influence the choice of postsurgical discharge setting. Using a retrospective cohort design, we linked 11,083 veterans who had hip fracture surgeries in a Department of Veterans Affairs (VA) hospital from 1998 to 2005 as assessed by the VA National Surgical Quality Improvement Program dataset with administrative data. The factors associated with five postdischarge settings were analyzed using multinomial logistic regression. We found that few veterans (0.8%) hospitalized for hip fracture were discharged with home health. Higher proportions of veterans were discharged to a nursing home (15.4%), to outpatient rehabilitation (18.8%), to inpatient rehabilitation (16.9%), or to home (48.2%). Patients were more likely to be discharged to nonhome settings for VA-provided rehabilitation if they had total function dependence, had American Society of Anesthesiologists class 4 or 5, had surgical complications prior to discharge, or lived in counties with lower nursing home bed occupancy rates. Future research should compare postsurgical and longer-term morbidity, mortality, and healthcare utilization across these rehabilitation settings.

Timing of Adverse Events Following Geriatric Hip Fracture Surgery: A Study of 19,873 Patients in the American College of Surgeons National Surgical Quality Improvement Program

“…Figure 2 provides the summary statistics for adverse events diagnosed in the first 30 postoperative days. The median postoperative day of diagnosis (and the interquartile range) was 3 (1-5) for myocardial infarction, 3 (0-8) for cardiac arrest requiring cardiopulmonary resuscitation, 3 (1-10) for stroke, 4 (2-10) for pneumonia, 4 (2-11) for pulmonary embolism, 7 (2-13) for urinary tract infection, 9 (4-16) for deep vein thrombosis, 9 (4-18) for sepsis, 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) for mortality, and 16 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) for surgical site infection. Figure 3 depicts the timing of adverse events relative to discharge.…”

“…The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) is a relatively new and growing surgical registry. 1,3,[13][14][15][16][17][18][19][20][21][22] The registry follows up patients undergoing surgical procedures at several hundred community and academic institutions nationwide. Unlike the administrative datasets discussed above, the ACS-NSQIP characterizes the postoperative day of diagnosis of well-defined adverse events during the first 30 postoperative days.…”

Post-acute pathways among hip fracture patients: a system-level analysis

“…There are few published studies that describe geographic variation in the proportion of hip fracture patients immediately discharged to IPR or the community [ 50 , 51 , 54 ]. Neuburger et al [ 54 ] found that within one geographical area in the United Kingdom, there was wide variation (between 2.1 and 54.7 %) in hospital discharge practices with regards to the proportion of hip fracture patients discharged to community rehabilitation.…”

“…Prevalent complications and co-morbid conditions that arose during index acute care admission were captured using ICD10CA codes. These conditions included: Delirium (ICD10CA F050, F051, F058, F059) or dementia (ICD10CA F013, F018, F019, F030); and malignant neoplasm ((ICD10CA C0-C9) [ 29 , 30 , 37 – 39 , 50 , 84 , 85 ]. Risk factors for frailty were also collected (possession of 1 or more is a known indicator of frailty): Chronic kidney disease (ICD10CA N181-N185, N189); acidosis (ICD10CA E872); liver cirrhosis (ICD10CA K743-K746); diabetes (ICD10CA E10-E13); chronic heart failure (ICD10CA I50); peripheral arterial disease (ICD10CA I739); COPD (ICD10CA J40-J44) [ 73 ].…”

“…Pre-morbid living condition (i.e., institutionalization versus non-institutionalization) is also a predictor of post-acute discharge setting after hip fracture repair [ 6 , 29 , 53 ]. Furthermore, evidence from the United States, England, and Canada suggests there is variation, even within a single health region, in the proportion of patients that are immediately discharged to each post-acute setting [ 50 , 51 , 54 ]. There are currently no studies that describe hip fracture care pathways or patient characteristics after this immediate discharge destination and throughout the entire first year after a hip fracture (which is considered to be the length of time that health care use can be attributable to the hip fracture) [ 15 , 55 ].…”