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Discharge destination after hip fracture: findings from the Irish hip fracture database

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Key Summary Points

AbstractSection Aim

To identify factors influencing Discharge Directly Home (DDH) from an acute hospital following hip fracture, as opposed to Discharge to an Alternative Location (DAL).

AbstractSection Findings

Younger patients who were independently mobile pre-fracture were more likely to be DDH. Timely surgery with early post-operative mobilisation and a shorter length of stay increased the odds of DDH.

AbstractSection Message

The Irish Hip Fracture Standards incorporate 2 out the 3 modifiable factors identified in this paper, which reinforces the importance of the IHFS in improving patient outcomes.

Abstract

Purpose

Although home continues to be the place from which the majority of patients are admitted, less than one third of patients are Discharged Directly Home (DDH) following hip fracture. Once ready for discharge, DDH as opposed to Discharge to an Alternative Location (DAL), i.e., community care, rehabilitation facility or long-term care, is a high priority for patients and clinicians alike. Not only is DDH integral to the quality of life of patients, it is also an essential driver of the socioeconomic cost of hip fracture care.

Methods

We analysed 21,819 cases in the Irish Hip Fracture Database from 2013 to 2019. Descriptive and analytical statistics were conducted.

Results

29% (n = 6476) of patients were DDH during the study period. On multivariate analysis, the odds of DDH decreased as age increased (OR 0.28, p < 0.01, 95% CI 0.24–0.34). Patients who were independently mobile prior to fracture were 47% more likely to be DDH (OR 1.47, p < 0.01, 95% CI 1.29–1.68). Those mobilised early post operatively were 24% more likely to be DDH (OR 1.24, p < 0.01, 95% CI 1.06–1.45). Patients who waited > 72 h prior to surgery were 30% less likely to be DDH (OR 0.70, p < 0.01, 95% CI 0.56–0.88).

Conclusion

The authors identified patient characteristics that increased the likelihood of DDH, i.e., younger patients independently mobile prior to fracture, who received timely surgery and early post-operative mobilisation. The Irish Hip Fracture Standards (IHFS) incorporate 2 out the 3 modifiable factors identified, which reinforces the importance of the IHFS in improving patient outcomes.

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Funding

No funding, grants or financial support was received.

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Authors and Affiliations

  1. Department of Public Health, Health Service Executive - South, Cork, Ireland

    H. Ferris

  2. National Office of Clinical Audit, Dublin, Ireland

    L. Brent

  3. Healthcare Outcomes Centre, Royal College of Surgeons, Dublin, Ireland

    J. Sorensen

  4. Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland

    E. Ahern

  5. Department of Age Related Health Care, Tallaght University Hospital, Dublin, Ireland

    T. Coughlan

Authors
  1. H. Ferris
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  2. L. Brent
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  3. J. Sorensen
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  4. E. Ahern
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  5. T. Coughlan
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Correspondence to H. Ferris.

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Research ethics approval was obtained from the St James Hospital/ Tallaght University Hospital Research Ethics Committee, in accordance with the European Communities (Clinical Trials on Medicinal Products for Human Use) Regulations 2004 & ICH GCP Guidelines.

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Ferris, H., Brent, L., Sorensen, J. et al. Discharge destination after hip fracture: findings from the Irish hip fracture database. Eur Geriatr Med 13, 415–424 (2022). https://doi.org/10.1007/s41999-021-00556-7

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  • DOI: https://doi.org/10.1007/s41999-021-00556-7

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