Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission

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• 作者：Peter Nordstr&ouml ; m^a ; ^{peter.nordstrom@germed.umu.se" class="auth_mail" title="E-mail the corresponding author} ; Karl Michaë ; lsson^b ; Ami Hommel^c ; Per Ola Norrman ; MD^c ; Karl-G&ouml ; ran Thorngren^c ; Anna Nordstr&ouml ; m^d
• 关键词：Hip fracture ; geriatric rehabilitation ; death ; readmission
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 January 2016
• 年：2016
• 卷：17
• 期：1
• 页码：91.e1-91.e7
• 全文大小：704 K

文摘

To investigate the effects of geriatric rehabilitation on short-term risk of death and readmission after a hip fracture were investigated in a nationwide cohort. In addition, the association of discharge location (nursing home or patient's home) with the short-term risk of death was assessed.

Design, Setting, and Participants

The cohort consisted of 89,301 individuals at least 50 years of age, with a first hip fracture registered in the Swedish quality register RIKSHÖFT, the years 2004–2012.

Measures

Short-term risk of death and readmission to hospital after discharge was compared at 8 hospitals, where most patients received inpatient care in geriatric wards, and those treated at 71 regular hospitals.

Results

The risks of death within 30 days of admission were 7.1% in patients admitted to geriatric ward hospitals and 7.4% in those treated at regular hospitals (multivariable-adjusted hazard ratio [HR] 0.91, 95% CI 0.85–0.97), whereas the odds of readmission within 30 days of discharge were 8.7% and 9.8%, respectively (multivariable-adjusted odds ratio 0.86, 95% CI 0.81–0.91). The risk of death was influenced by discharge location and inpatient length of stay (LOS). Thus, for patients discharged to short-term nursing homes with a LOS of at most 10 days, each additional day of LOS reduction increased the risk of death within 30 days of discharge by 13% (HR 1.13, 95% CI 1.08–1.18). This association was reduced in patients discharged to permanent nursing homes (HR 1.04, 95% CI 1.02–1.07), and not significant in those discharged to their own home (OR 1.00, 95% CI 0.91–1.10).

Conclusion

The risks of death and readmission were lower in patients with hip fracture who received care in hospitals with geriatric wards. The risk of death after discharge increased with shorter LOS, especially in patients discharged to short-term nursing homes.