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. 2021 Jan;9(1):70-78.
doi: 10.22038/abjs.2020.46476.2276.

Factors for Increased Hospital Stay and Utilization of Post -Acute Care Facilities in Geriatric Orthopaedic Fracture Patients

Quirine M J Van Der Vliet  1   2 , Michael J Weaver  1   3 , Koloman Heil  1   4 , Michael F McTague  1   3 , Marilyn Heng  1   5
Affiliations

Factors for Increased Hospital Stay and Utilization of Post -Acute Care Facilities in Geriatric Orthopaedic Fracture Patients

Quirine M J Van Der Vliet et al. Arch Bone Jt Surg. 2021 Jan.

Abstract

Background: This study aims to determine the extent of utilization of health care resources in the geriatric fracture population and to identify factors associated with burden on resources.

Methods: This is a retrospective study of 1074 patients ≥65 years admitted to an orthopaedic service for a long bone fracture between July 2014 - June 2015. Outcomes were hospital length of stay (LOS), discharge disposition, and post-acute care facility LOS. Secondarily, readmission rates and mortality were assessed. Multivariable regression was performed to identify factors associated with utilization.

Results: Prior to injury, 96% of patients lived at home and 50% ambulated independently. Median hospital LOS was 5 days (IQR 3 - 7). 878 patients were discharged to a rehabilitation facility, with 45% being discharged <20 days. Ten percent of patients (n = 108) were re-admitted <90 days of their discharge. 924 patients were still alive one year after the injury. Higher Charlson Comorbidity Index (CCI) (P=0.048), male sex (P<0.001), pre-injury use of an ambulatory device (P = 0.006), and undergoing surgical treatment (P<0.001) were associated with longer hospital LOS. Older age (P<0.001), pre-injury ambulatory device (P=0.001), and surgery (P=0.012) were risk factors for requiring discharge to another inpatient facility. Older age (P<0.001), pre-injury ambulatory aid (P<0.001), and pre-existing immobility (P<0.001) were independent risk factors for LOS >20 days in a rehabilitation facility. Discharge home was not found to be associated with an increase in 1-year mortality after adjusting for age, CCI, sex, fracture location, and surgery (P=0.727). Shorter LOS in rehabilitation facilities (<20 days) was also not associated with an increase in 1-year mortality (P=0.520).

Conclusion: Elderly fracture patients utilize a significant amount of post-acute care resources and age, CCI, surgery, fracture location, pre-injury ambulatory status, and pre-injury living status were found to be associated with the use of these resources.

Keywords: Bundled payments; Fracture; Geriatric; Healthcare utilization; Length of stay; Post-acute care; Rehabilitation.

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Figures

Figure 1
Figure 1
Fracture locations
Figure 2
Figure 2
a) Hospital discharge disposition, b) Rehabilitation discharge disposition
See this image and copyright information in PMC

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