Optimizing Rehabilitation Transitions in Older Hip Fracture Patients: Delays, Determinants, and Outcomes

PURPOSE: To identify subgroups of older adults with hip fractures who are more likely to experience delayed discharge from acute orthopedic hospitalization to postacute rehabilitation and to examine the impact of such delays on adverse events and short-term outcomes. DESIGN: Retrospective cohort study conducted between 2018 and 2022 at a large tertiary hospital in north-central Israel. METHODS: The study included 474 adults aged ≥65 years hospitalized for hip fracture surgery and eligible for postacute rehabilitation (inpatient or home-based). Analyses evaluated predictors of delayed discharge from acute orthopedic hospitalization to postacute rehabilitation. We examined adverse events occurring after rehabilitation approval and before acute hospitalization discharge (infections, falls, and in-hospital mortality), early postdischarge outcomes (re-hospitalization and re-operation), and hospitalization costs . FINDINGS: Delayed discharge occurred in 61.4% of patients, with a mean delay of 3.5 days. In unadjusted analyses, delayed discharge was associated with higher rates of infections, falls, and mortality. In multivariable models adjusting for age and rehabilitation pathway, delayed discharge remained independently associated with healthcare-acquired infections (OR=3.09, 95% CI: 1.62-5.90, p<.001), but not with mortality. Referral to inpatient rehabilitation was also independently associated with infection risk (OR=2.21, 95% CI: 1.10-4.45, p=.026). CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Early identification of patients at risk for delayed transition to postacute rehabilitation may support proactive discharge planning, infection prevention strategies, and coordinated care across settings. CONCLUSIONS: Delayed transition from acute orthopedic hospitalization to postacute rehabilitation is independently associated with increased risk of healthcare-acquired infection and higher hospitalization costs. Reducing avoidable acute care days through improved coordination may enhance patient safety and system efficiency.