From the Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
J Am Acad Orthop Surg. 2020 Sep 15;28(18):743-749. doi: 10.5435/JAAOS-D-19-00073.
Among surgical patients, utilization of institutional-based postacute care (PAC) presents a notable financial burden and is associated with increased risk of complications and mortality rates when compared with discharge home. The purpose of this study was to identify predictors of postdischarge disposition to PAC in geriatric patients after surgical fixation of native hip fractures.
We have done a query of the American College of Surgeons National Surgical Quality Improvement Program to identify geriatric (≥65 years) patients who sustained surgical femoral neck, intertrochanteric, and subtrochanteric hip fractures in 2016. Multivariate regression was used to compute risk factors for discharge to and prolonged stay (>30 days) in PAC.
Eight thousand one hundred thirty-three geriatric hip fracture patients with sufficient follow-up data were identified. Of these, 6,670 patients (82.0%) were initially discharged to PAC after their hip fracture episode of care, and 2,986 patients (36.7%) remained in PAC for >30 days. Age (odds ratio [OR] 1.06 [1.05 to 1.08], P < 0.001), partial (OR 2.41 [1.57 to 3.71], P < 0.001) or total dependence (OR 3.03 [1.92 to 4.46], P < 0.001) for activities of daily living, dementia (OR 1.62 [1.33 to 1.96], P < 0.001), diabetes (OR 1.46 [1.14 to 1.85], P = 0.002), hypertension (OR 1.32 [1.10 to 1.58], P = 0.002), and total hospital length of stay (OR 1.04 [1.01 to 1.08], P = 0.006) were independent risk factors for discharge to PAC. Age (OR 1.05 [1.04 to 1.06], P < 0.001), partial (OR 2.86 [1.93 to 3.79], P < 0.001) or total dependence (OR 3.12 [1.45 to 4.79], P < 0.001) for activities of daily living, American Society of Anesthesiologist's classification (OR 1.27 [1.13 to 1.43], P < 0.001), dementia (OR 1.49 [1.28 to 1.74], P < 0.001), and total hospital length of stay (OR 1.10 [1.08 to 1.13], P < 0.001) were independent risk factors for prolonged PAC stay >30 days.
Discharge to PAC is the norm among patients undergoing hip fracture surgery. Provider foreknowledge of risk factors may help improve hip fracture outcomes and decrease healthcare costs.
在外科患者中，利用机构为基础的术后康复治疗（PAC）会带来显著的经济负担，并且与出院回家相比，会增加并发症和死亡率的风险。本研究的目的是确定在接受手术固定原生髋关节骨折的老年患者中，出院后 PAC 处置的预测因素。
我们对美国外科医师学会国家手术质量改进计划进行了查询，以确定 2016 年因手术股骨颈、转子间和转子下型髋关节骨折而接受治疗的老年（≥65 岁）患者。多变量回归用于计算出院到 PAC 并延长（>30 天）PAC 住院时间的风险因素。
确定了 8133 名有足够随访数据的老年髋关节骨折患者。其中，6670 名患者（82.0%）在髋关节骨折治疗后最初出院到 PAC，2986 名患者（36.7%）在 PAC 停留>30 天。年龄（优势比[OR]1.06[1.05 至 1.08]，P<0.001）、部分（OR 2.41[1.57 至 3.71]，P<0.001）或完全依赖（OR 3.03[1.92 至 4.46]，P<0.001）日常生活活动能力、痴呆（OR 1.62[1.33 至 1.96]，P<0.001）、糖尿病（OR 1.46[1.14 至 1.85]，P=0.002）、高血压（OR 1.32[1.10 至 1.58]，P=0.002）和总住院时间（OR 1.04[1.01 至 1.08]，P=0.006）是出院到 PAC 的独立危险因素。年龄（OR 1.05[1.04 至 1.06]，P<0.001）、部分（OR 2.86[1.93 至 3.79]，P<0.001）或完全依赖（OR 3.12[1.45 至 4.79]，P<0.001）日常生活活动能力、美国麻醉师协会分类（OR 1.27[1.13 至 1.43]，P<0.001）、痴呆（OR 1.49[1.28 至 1.74]，P<0.001）和总住院时间（OR 1.10[1.08 至 1.13]，P<0.001）是 PAC 延长（>30 天）住院时间的独立危险因素。
在接受髋关节骨折手术的患者中，出院到 PAC 是常规治疗方法。提供者了解风险因素可以帮助改善髋关节骨折的结果并降低医疗保健成本。
