factors for increased hospital stay and utilization of post -acute care facilities in geriatric orthopaedic fracture patients

Background: this study aims to determine the extent of utilization of health care resources in the geriatric fracture population and to identify factors associated with burden on resources. methods: this is a retrospective study of 1074 patients ≥65 years admitted to an orthopaedic service for a long bone fracture between july 2014 - june 2015. outcomes were hospital length of stay (los), discharge disposition, and post-acute care facility los. secondarily, readmission rates and mortality were assessed. multivariable regression was performed to identify factors associated with utilization. results: prior to injury, 96% of patients lived at home and 50% ambulated independently. median hospital los was 5 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 one year after the injury. higher charlson comorbidity index (cci) (p=0.048), male sex (p<0.001), pre-injury use of an ambulatory device (p = 0.006), and undergoing surgical treatment (p<0.001) were associated with longer hospital los. older age (p<0.001), pre-injury ambulatory device (p=0.001), and surgery (p=0.012) were risk factors for requiring discharge to another inpatient facility. older age (p<0.001), pre-injury ambulatory aid (p<0.001), and preexisting immobility (p<0.001) were independent risk factors for los >20 days in a rehabilitation facility. discharge home was not found to be associated with an increase in 1-year mortality after adjusting for age, cci, sex, fracture location, and surgery (p=0.727). shorter los in rehabilitation facilities (<20 days) was also not associated with an increase in 1-year mortality (p=0.520). conclusion: 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 of these resources.