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

Document Type : RESEARCH PAPER

Authors

1 1 Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA 2 University Medical Center Utrecht, Utrecht, Netherlands

2 1 Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA 2Brigham and Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, USA

3 1 Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA 2Paracelsus Medical University, Salzburg, Austria

4 1 Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA 2 Brigham and Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, USA

5 1 Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA 2 Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA

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 preexisting
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.
Level of evidence: III

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