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

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. 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. 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). 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