• Dieuwke van Dartel, Marloes Vermeer, Ellis C Folbert, Arend J Arends, Vollenbroek-HuttenMiriam M RMMRBiomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; ZGT Academy, Ziekenhuisgroep Twente, Almelo, the Netherlands., Johannes H Hegeman, and Dutch Hip Fracture Audit (DHFA) Group.
• Biomedical Signals and Systems Group, University of Twente, Enschede, the Netherlands; Department of Trauma Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands. Electronic address: d.vandartel@utwente.nl.
• J Am Med Dir Assoc. 2021 Dec 1; 22 (12): 2454-2460.

ObjectiveTo investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery.DesignRetrospective cohort study.Setting And ParticipantsData from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included.MethodsPatients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors.ResultsHigher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively.Conclusions And ImplicationsThis study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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