Key result
Early orthopedic follow-up (≤28 days) after hip fracture surgery was associated with a 6.2% readmission rate compared to 5.4% for late and 18.9% for no orthopedic follow-up (p<0.001).
Why the study?
Many elderly patients do not return for recommended postoperative visits after hip fracture surgery, and it was unknown whether early follow-up changes orthopedic management.
Does early orthopedic follow-up change post-operative management or readmission rates in elderly patients after hip fracture surgery?
Cohort (n=1,232)
Does early orthopedic follow-up change post-operative management or readmission rates in elderly patients after hip fracture surgery?
Absolute Event Rate: 6.2% vs 18.9%
p-value: p=<0.001
Early orthopedic follow-up after hip fracture surgery does not appear to change post-operative management, suggesting potential implications for value-based care.
Early and late orthopedic follow-up showed similar readmission rates after hip fracture; leaves open the value of routine early visits in value-based care.
INTRODUCTION: Despite the recommendation for postoperative orthopedic follow-up after a hip fracture in elderly patients, many patients do not return for these visits. In this study, we attempt to determine if early follow-up (<4 weeks post-discharge) changes orthopedic post-operative management. MATERIALS AND METHODS: 1232 patients aged > 55 years old who underwent operative fixation for hip fractures were enrolled into an orthopedic trauma registry and followed from hospitalization through one year. Demographics, comorbidities, injury severity, and hospital course data were collected. Need for readmission and orthopedic follow-up were ascertained through chart review. RESULTS: 417 patients (33.8%) patients did not return for any follow-up and 30 (2.4%) patients died <30 days from discharge. 370 (45.5%) patients had early orthopedic follow-up ≤28 days after discharge. 317 (38.9%) patients were seen ≥29 days after discharge (late follow-up). 127 (15.6%) patients returned for isolated non-orthopedic care. There were 23 (6.2%) readmissions in the early group, 17 (5.4%) in the late group, and 24 (18.9%) in the no follow-up group (p < 0.001). Patients discharged home were more likely to present for early follow-up compared to those with late and non-orthopedic follow-up (p = 0.002), however there was no difference in readmission rates between those discharged home vs. SNFs/SARs. DISCUSSION: Patients who received isolated non-orthopedic follow-up within 4 weeks of surgery experienced more hospital readmissions than those with follow-up in that time period; however, these readmissions were primarily due to medical issues. There was no difference in orthopedic-related readmissions and changes in orthopedic management between groups. Patients discharged to SNFs/SARs did not present for early orthopedic as often as those discharged home. CONCLUSION: Early orthopedic follow up after hip fracture care does not change post-operative management in these patients and has implications for value-based care. LEVEL OF EVIDENCE: Prognostic Level III.
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Ganta et al. (2021) conducted a cohort in Hip fracture (n=1,232). Early orthopedic follow-up (≤28 days after discharge) vs. Late follow-up (≥29 days) or isolated non-orthopedic care was evaluated on Hospital readmission (p=<0.001). Early orthopedic follow-up (≤28 days) after hip fracture surgery was associated with a 6.2% readmission rate compared to 5.4% for late and 18.9% for no orthopedic follow-up (p<0.001).
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