Background Early determination of hospital discharge destination is critical for adult patients hospitalized with pathologic fractures as they require attentive postoperative multidisciplinary care. There is a paucity of studies that investigate risk factors for non-home discharge in this vulnerable patient population. This study aimed to examined the impact of health insurance type and New York State region on hospital discharge disposition for adult patients admitted with pathologic fractures. Methods The New York Statewide Planning and Research Cooperative System (SPARCS) database identified 1133 patients aged 18 years and older admitted to a public or private hospital in New York state between January 1st of 2020 and December 31st of 2022 with pathologic fractures. Multinomial logistic regression analysis was used to examine the relationship between insurance type or New York State region and discharge disposition (inpatient/skilled nursing facility, hospice, compared home or home with home health services). The model accounted for potential confounders, including age, sex, race, severity of illness, and risk of mortality. Results Compared to patients with commercial insurance, patients with Medicare were 2.7 (95% CI, 1.4-5.2) more likely to be discharged to inpatient rehabilitation or skilled nursing facility than home. Compared to patients with commercial insurance, patients with Medicare were 2.7 (95% CI, 1.2-6.1) and patients with Medicaid were 2.5 (95% CI, 1.0-6.2) more likely to be discharged to hospice than home. Compared to patients in New York City, patients in the Hudson Valley region were 2.3 (95% CI, 1.3-4.1) more likely to be discharged to in-patient rehabilitation or a skilled nursing facility than home. Patients in Long Island were 1.9 (95% CI, 1.1-3.2) and Hudson Valley were 4.2 (95% CI, 2.0-8.6) more likely than those in New York City to be discharged to hospice. Patients in Central New York (RRR 2.7, 95% CI 1.3-5.5) were more likely to expire during the hospitalization than patients in New York City. Conclusions Our study found Medicare or Medicaid payor status were significant predictors of hospital discharge disposition for adult patients hospitalized with pathologic fractures. Regional variance exists across New York State which may reflect access to care and historical patterns of care. High-quality care coordination is critically important for cancer patients whose care extends longitudinally from hospital acute care to ambulatory care and involves multiple medical specialties. Level of Evidence Level III, Diagnostic Study.
Koltenyuk et al. (Sun,) studied this question.