Influence of patients’ walking ability at one-week post-proximal femur fracture surgery on the choice of discharge destination in Japan

Abstract

With the innovation of healthcare delivery systems, a need for early determination of patients' discharge outcomes arises after proximal femur fracture surgery, to reduce the burden on healthcare infrastructure. Several studies have examined the extent of walking ability early in the postoperative period to predict the outcome destination. In this study, as an additional validation of these studies, we examined the effect of walking ability on the hospital discharge prognosis of patients in the first week after proximal femur fracture surgery in Japan. [Participants and Methods] Medical records of 228 patients with proximal femur fractures, aged ≥75 years old, admitted between April 2015 and March 2019, were retrospectively analyzed. The objective variable was discharge destination. The main evaluation factor was walking ability one-week post-surgery. [Results] Good walking ability and the company of a relative living together one week post-surgery were significant determining factors of discharge destination. [Conclusion] The ability to walk and the presence of a co-resident one week after surgery increased the likelihood of proximal femur fracture patients to be discharged directly to home. Our findings may help rehabilitation professionals make better decisions regarding discharge destination.

Factors Associated with Discharge Destination in Patients with Bone Metastases

“…Many studies have shown that ADL on admission and discharge were predictors of discharge destination of stroke patients [ 9 , 19 , 20 ]. The discharge destination predictors have been reported for several diseases, including spinal cord injury and post-proximal femoral fracture [ 21 , 22 ]. Regarding bone metastasis, a previous retrospective observational study reported that the discharge destination was associated with discharge ADL, and the cut-off value of the Barthel Index was 72.5 [ 13 ].…”

Loss of Independence after Index Hospitalization Following Proximal Femur Fracture: A Narrative Review

“…highlights the relation of the staying with co-residents or family members and walking ability after 1 week of PFF surgery i.e., Barthel Index at discharge of Home group v/s Hospital referred group (75.6 ± 22.7 )v/s(58.0 ± 24.6), p value<0.01,odds ratios are walking ability one week after surgery 1.9, p <o.o5,staying with Co-residents 4.6, p < o.o1. [24] Suguru Ohsawa et.al study suggest that all the patients in the assertive rehabilitation group recovered their ability to walk (FIM score) to some extent, while those in the conventional group did not. Ambulationd (FIM): Assertive method (18.29+/-7.9) v/s Conventional method (9.49+/-4.3, p-value=0.00135).…”

“…study from showed that Japan's long-term care insurance system that allow elderly people to receive appropriate support in their daily living according to their level of independence and physical and mental functions which is not present in developed country of world. [24] Comparing studies from developed to developing country the study of Kyle T. Judd et.al based in USA showed the average cost of the early intervention per patient was $49,900 and the average cost of late intervention per patient was $65,300 (p= 0.0086) [25] while R. Aigner et.al. study based in India showed that the mean total acute care costs per patient was 8853 € ± 5676 €.…”

“…This reflects that the proportional increase in cost of management of PFF in developed country will be a burden in near future. [24,34] The cost is higher due to longer hospital stay which accounts for nearly one third of total cost of treatment. [34] Further, rapid intervention for fracture management significantly decreases the burden of higher expense in treatment.…”

“…Adding more to it, cognitive impairment also has a significant role in increasing the acute care costs. [24,34] Also, according to few studies, level of trauma centers plays a significant role in the timing of intervention that impacts the disposition and recovery period for these fractured population. [35,36] These findings may be best interpreted by considering loss of independence and the need for discharge to a faculty other than home.…”