Preinjury Factors that Influence the Outcome of Patients with Hip Fracture

Abstract

Background: The question of whether patients with hip fracture can be discharged home or require hospital transfer for additional rehabilitation is critical. The same clinical pathway is not suitable for all patients. However, there are no clear indices for establishing the appropriate clinical pathway. To address this, we examined preinjury factors, including the Barthel index (BI), and performed logistic regression analysis to identify factors affecting the outcome (direct home discharge or hospital transfer) of patients with hip fracture. Materials and methods: Patients with hip fracture who underwent surgery at Yokohama City University hospital were consecutively enrolled, and clinical data were retrospectively reviewed. Intergroup (direct home discharge or hospital transfer) comparison was performed using Student's t test (continuous variables) and Fisher's exact test (categorical variables). Factors affecting outcome were determined by logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used to identify the cutoff level, sensitivity, and specificity of the identified factors. Results: The preinjury BI scores for patients discharged home directly were significantly higher (p<0.01) and age was significantly lower (p<0.05) than for those transferred to another hospital. The american society of anesthesiologists physical status (ASA-PS) for patients discharged home was significantly (p<0.05) less than that for transferred patients. Logistic regression analysis revealed that preinjury BI scores and older age affected outcome whereas the ASA-PS did not. ROC curve analysis revealed that patients with preinjury BI <85 and aged >79 were difficult to discharge directly home and were more likely to be transferred to another hospital (95.6% sensitivity and 62.9% specificity). Conclusions: Low preinjury BI scores (<85) and higher age (>79) indicate a requirement for a cooperative pathway between regional hospitals that ensures a smooth hospital transfer.