124factors Affecting 30 Day Readmission of Hip Fracture Patients Discharged From Orthogeriatric Unit

Our aim was to identify factors that could predict readmission rates in older patients following surgical intervention. We looked at 30-day re-admission rates of older patients following hip fracture surgery. National Hip Fracture Database (NHFD) was used to identify patients admitted to an Orthogeriatric Unit between July and December 2014. We identified patients re-admitted within 30 days of discharge using patient tracking software (Enterprise CAMIS). Patients’ clinical notes and NHFD were reviewed for factors contributing towards readmission. Of the total 257 patients, 29 were readmitted within 30 days (10 males and 19 females), with an age range 65-93 years (median 81 yrs). 93% were readmitted due to medical reasons: respiratory being the most common (44%). Majority of patients readmitted had pre-existing cardiovascular (62%) and respiratory conditions (45%). Patient mobility impacted on readmission: those with poor pre-fracture mobility had a higher incidence (83%); patients not mobilised on day after surgery had a 76% readmission rate. Patients discharged to their pre-fracture residence had higher readmissions (41%), compared to those discharged to rehabilitation units (34%) or those newly admitted to 24 hour care (24%). Only 1 in 3 patients returned to their usual place of residence after readmission. Lack of mobility before and after surgery had a major impact on readmission rates. Pre-existing factors influencing readmission were cardiovascular and respiratory conditions. Our experience shows the incidence of 30-day readmission was 11%, which is in keeping with other studies. [1, 2] Patients were less likely to be readmitted if they were in intermediate care facilities. We would recommend their use in post-operative discharge planning. We would highly recommend regular physiotherapy-directed mobilisation and chest exercises as part of an enhanced post-operative recovery programme in older patients. Particular attention should be given to patients with pre-existing medical conditions and reduced mobility, as they seem to be more vulnerable.