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

Background: This study aims to determine the extent of utilization of health care resources in the geriatric fracturepopulation 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 bonefracture between July 2014 - June 2015. Outcomes were hospital length of stay (LOS), discharge disposition, andpost-acute care facility LOS. Secondarily, readmission rates and mortality were assessed. Multivariable regression wasperformed to identify factors associated with utilization.Results: Prior to injury, 96% of patients lived at home and 50% ambulated independently. Median hospital LOS was5 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 oneyear after the injury. Higher Charlson Comorbidity Index (CCI) (P=0.048), male sex (P<0.001), pre-injury use of anambulatory device (P = 0.006), and undergoing surgical treatment (P<0.001) were associated with longer hospitalLOS. Older age (P<0.001), pre-injury ambulatory device (P=0.001), and surgery (P=0.012) were risk factors forrequiring discharge to another inpatient facility. Older age (P<0.001), pre-injury ambulatory aid (P<0.001), and preexistingimmobility (P<0.001) were independent risk factors for LOS >20 days in a rehabilitation facility. Dischargehome was not found to be associated with an increase in 1-year mortality after adjusting for age, CCI, sex, fracturelocation, and surgery (P=0.727). Shorter LOS in rehabilitation facilities (<20 days) was also not associated with anincrease 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 ofthese resources.Level of evidence: III

Keywords:

bundled payments , Fracture , Geriatric , healthcare utilization , Length of stay , post-acute care , Rehabilitation