Discharge to inpatient care facilities following hip fracture surgery: incidence, risk factors, and 30-day post-discharge outcomes.

Abstract

Discharge to an inpatient care facility (skilled-care or rehabilitation) has been shown to be associated with adverse outcomes following elective total joint arthroplasties. Current evidence with regard to hip fracture surgeries remains limited. The 2015-2016 ACS-NSQIP database was used to query for patients undergoing total hip arthroplasty, hemiarthroplasty and open reduction internal fixation for hip fractures. A total of 15,655 patients undergoing hip fracture surgery were retrieved from the database. Inpatient facility discharge included discharges to skilled-care facilities and inpatient rehabilitation units. Multi-variate regression analysis was used to assess for differences in 30-day post-discharge outcomes between home-discharge versus inpatient care facility discharge, while adjusting for baseline differences between the 2 study populations. A total of 12,568 (80.3%) patients were discharged to an inpatient care facility. Discharge to an inpatient care facility was associated with higher odds of any complication (OR 2.03 [95% CI, 1.61-2.55]; <i>p <</i> 0.001), wound complications (OR 1.79 [95% CI, 1.10-2.91]; <i>p =</i> 0.019), cardiac complications (OR 4.49 [95% CI, 1.40-14.40]; <i>p =</i> 0.012), respiratory complication (OR 2.29 [95% CI, 1.39-3.77]; <i>p =</i> 0.001), stroke (OR 7.67 [95% CI, 1.05-56.29]; <i>p =</i> 0.045, urinary tract infections (OR 2.30 [95% CI, 1.52-3.48]; <i>p <</i> 0.001), unplanned re-operations (OR 1.37 [95% CI, 1.03-1.82]; <i>p =</i> 0.029) and readmissions (OR 1.38 [95% CI, 1.16-1.63]; <i>p <</i> 0.001) following discharge. Discharge to inpatient care facilities versus home following hip fracture surgery is associated with higher odds of post-discharge complications, re-operations and readmissions. These results stress the importance of careful patient selection prior to discharge to inpatient care facilities to minimise the risk of complications.