Associations between hospital-based rehabilitation for hip fracture and two-year outcomes for mortality and independent living: An Australian database study of 1,724 elderly community-dwelling patients.

Abstract

OBJECTIVE: To compare rates of mortality, hospital readmissions and independent living status for 2 years following hip fracture in community-dwelling patients with and without hospital-based rehabilitation. DESIGN: Retrospective cohort study. METHODS: Administrative data-sets were linked for hospital treatment, residential aged care admissions, selected community services and date of death for community-dwelling hip fracture patients. Mortality, readmissions, residency within aged care facilities and independent living status at intervals up to 2 years were compared in multivariate logistic regression for patients with and without hospital-based rehabilitation. RESULTS: Age, sex and comorbidity distributions were similar for 1,050 patients who received rehabilitation and 674 patients who did not. Rehabilitation added 11 days to total hospital stay and $AUD 12,000 to hospital costs. Mortality at 90 days after hip fracture was 4.7% for rehabilitation patients vs 10.7% for others (p < 0.001), and 26.2% vs 37.2% (p < 0.001) at 2 years. Beyond 90 days there was no significant association between receipt of rehabilitation and the proportion of patients meeting criteria for independent living. Hospital readmissions in the year following the index fracture were not significantly different. CONCLUSION: In-hospital rehabilitation substantially increases total hospital costs. It is associated with improved early and late survival, but not with the likelihood of living independently for up to 2 years after hip fracture.