Identifying a clinical decision tool to predict discharge disposition following operative treatment of hip fractures in the United States. Issue 4 (April 2020)

• Record Type: Journal Article
• Authors: Sivasundaram, Lakshmanan; Tanenbaum, Joseph E; Mengers, Sunita RP; Trivedi, Nikunj N; Su, Charles A; Salata, Michael J; Ochenjele, George; Voos, James E; Wetzel, Robert J
• Is Part Of: Injury. Volume 51:Issue 4(2020)
• Page Start: 1015
• Page End: 1020
• Publication Date: 2020-04
• Subjects: Hip fractures -- Discharge -- Post-acute care -- Rehabilitation; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.02.108
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Increasing age is the strongest predictor of discharge to a post-acute care facility. ASA class greater than 2 increases likelihood of post-acute care disposition. Surgical approach for hip fracture fixation influences discharge destination. Abstract: Background: Post-discharge management following operative treatment of hip fractures continues to be performed on a case-by-case basis, with no uniform guidelines dictating management. Predicting discharge to post-acute care (PAC) facilities (i.e. skilled nursing facilities and inpatient rehabilitation facilities) can assist preoperative planning and potentially decrease length of stay secondary to disposition issues. The goal of this study was to develop a nomogram using easily identified variables to preoperatively predict discharge disposition following operative treatment of hip fractures. Methods: Using the National Surgical Quality Improvement Program database, patients who underwent surgical intervention for hip fractures between 2012 and 2015 were identified. A multivariable logistic regression model was used to identify risk factors for discharge to a PAC facility, and a predictive nomogram was created based on these results. Results: From 2012 to 2015, 33, 371 hip fractures were identified: 13, 336 (40%) femoral neck fractures, and 20, 035 (60%) intertrochanteric femur fractures. Of the patients identified, 26, 082 (78.2%) were discharged to a PAC while the remainder were discharged home with or without home health. 70% of patients were female and 92.4% were Caucasian. When accounting for comorbidities, using the American Society of Anesthesiologists (ASA) classification system, 6, 122 patients (18.4%) had 'Mild Systemic Disease' (ASA 2), 20, 872 (62.6%) patients had 'Severe Systemic Disease' (ASA 3), and 6, 006 (18.1%) had 'Life Threatening Disease' (ASA 4/5). The majority of patients were brought in from a 'Home' setting, while 10.4% of patients were admitted from a 'Long-Term Care' setting. After controlling for confounding variables, older age and increasing ASA class were predictive of an increased risk of discharge to a PAC. Diabetes, dyspnea, congestive heart failure, and chronic obstructive pulmonary disease were not associated with an increased risk of discharge to a PAC. Discussion: Discharge disposition following operative treatment of hip fractures can be reliably predicted using a nomogram with commonly identified preoperative variables. Level of evidence: Level III, Retrospective Cohort Design, Observational Study