Determinants of postsurgical discharge setting for male hip fracture patients

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Determinants of postsurgical discharge setting
for male hip fracture patients

• Matthew L. Maciejewski, PhD Tiffany A. Radcliff,
  PhD William G. Henderson, PhD Diane Cowper
  Ripley, PhD W. Bruce Vogel, PhD Elizabeth
  Regan, MD, PhD Evelyn Hutt, MD

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• Aim
• Examine patient, facility, and market factors
  that influence choice of postsurgical discharge
  setting.
• Relevance
• It is not known what factors influence
  postsurgical discharge setting for veterans
  hospitalized for hip fracture repair.

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Method

• Retrospective cohort design.
• Linked 11,083 veterans who had hip fracture
  surgeries in VA hospital 1998-2005 (VA National
  Surgical Quality Improvement Program dataset)
  with administrative data.
• Analyzed factors associated with 5 postdischarge
  settings by using multinomial logistic regression.

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Results

• Few (0.08) were discharged with home health.
• Higher proportions were discharged to
• Nursing home (15.4).
• Outpatient rehabilitation (18.8).
• Inpatient rehabilitation (16.9).
• Home (48.2).
• More likely discharged to nonhome settings for VA
  rehabilitation if they had
• Total function dependence.
• American Society of Anesthesiologists class 4 or
  5.
• Surgical complications before discharge.
• Residence in counties with lower nursing home bed
  occupancy rates.

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Conclusion

• Further research should compare postsurgical and
  longer-term morbidity, mortality, and healthcare
  utilization across these rehabilitation settings.