Anticoagulation drug use and rehabilitation outcomes in post-acute hip fractured patients

PURPOSE

To assess the relationship between anticoagulant use and rehabilitation outcomes in post-acute hip fracture patients.

METHODS

A retrospective study (1/2017 to 5/2019) of 299 hip fractured patients.

OUTCOME MEASURES

Functional Independence Measure (FIM) and the motor FIM's effectiveness.

RESULTS

Patients treated with anticoagulation drugs exhibited a significant longer latency time from fracture to surgery (U = -4.37, p < 0.001) and from surgery to rehabilitation (U=-2.27, p = 0.023), and a significantly higher rate of cardiovascular diseases (χ2=0.15, p= 0.023) compared with untreated patients. No significant differences between the two patient groups were found regarding the rate of blood transfusions, perioperative complications (infections, reoperation), or functional outcome measures.

CONCLUSIONS

Oral anticoagulants are not associated with rehabilitation outcomes of hip fracture patients.Implications rehabilitationAnticoagulation drug use is not associated with functional outcome of post-acute hip fracture patients.It is recommended to renew oral anticoagulants for patients on chronic treatment after surgery since no negative outcomes were found during rehabilitation under anticoagulant treatment and in light of the importance of these drugs in preventing thromboembolic complications.

The effectiveness of a physiatrist-led acute hospital based postoperative hip fracture inpatient rehabilitation program: A single-center retrospective study

Background

Postoperative hip fracture rehabilitation in Singapore has historically been carried out in both acute and community hospitals (CH). An increasing majority of patients with hip fractures now receive inpatient rehabilitation in CH, and it is often believed that Acute hospital (AH) - based rehabilitation may be less cost-effective than their CH counterparts. Objective: This retrospective study aims to review the effectiveness of an AH-based hip fracture postoperative rehabilitation program.

Methods

This study retrospectively reviewed the database of postoperative hip fracture patients who underwent a physiatrist-led AH-based inpatient rehabilitation from Jan 2010 to Dec 2016. The primary outcomes were the functional improvement assessed by functional independence measure (FIM) and FIM efficiency. The secondary outcome included the length of stay (LOS), successful discharge to home rate, mortality rate, and complication rate.

Results

A total of 293 cases were included in the study. After participation in the inpatient rehabilitation program, the mean total FIM increased from 83.9 ± 12.7 (mean ± SD) to 93.9 ± 16.2 ( p < .001). The motor FIM increased from 47.1 ± 10.9 to 56.1 ± 10.1 ( p < .001). 269 (91.8%) patients were successfully discharged home. Inpatient mortality was 0.3% (1/293). The complications rate during inpatient rehabilitation was 16.0% with urinary tract infection being the most frequent complication (10.2%). The median LOS for inpatient rehabilitation was 19 days (15, 28).

Conclusions

After completing a physiatrist-led postoperative hip fracture inpatient rehabilitation program in an acute hospital, patients demonstrated significant functional improvement ( p < .0001). The inpatient rehabilitation program has a high discharge home rate and low in-hospital mortality.

Factors Influencing Length of Stay and Discharge Destination of Patients with Hip Fracture Rehabilitating in a Private Care Setting

Background: Rehabilitation after a hip fracture has long-term importance, prompting some patients to utilise private services. Insufficient data regarding private rehabilitation in the UK can cause ambiguity and potential problems for all involved. Aim: The present study, involving patients with hip fractures rehabilitating in a private UK care setting, examined relationships between length of stay (LoS), discharge destination (DD) and 12 predictor variables. Methods: The variables included the retrospective measurement of the Functional Independence Measure. The variables were informed by a literature review and patient and public involvement. Retrospective data from the records of patients with hip fractures were utilised. Data were analysed using Spearman's rho, Mann-Whitney U, Kruskal-Wallis H and chi-squared tests as appropriate. Odds ratios, distribution quartiles and survivor analysis were also utilised. Results: The median length of stay (LoS) was 20.5 days: 82% returned home, 6.5% died and 11.5% remained as long-term residents. Significant relationships existed between LoS and age (p = 0.004), comorbidities (p = 0.001) and FIMadmission (p = 0.001). DD was associated with age (p = 0.007), delirium (p = 0.018), comorbidities (p = 0.001) and both FIMpre-fracture and FIMadmission (p = 0.000). Conclusions: Factors associated with length of stay were identified, but further research incorporating multiple sites is required for greater predictor precision. Discharge destination was evident by 90 days, facilitating long-term planning.

The effect of psychological resilience on functional outcomes in post-operative hip fracture patients in a Singapore community hospital

Background:

In Singapore, the number of hip fractures per year is projected to increase from 2500 to 9000 by 2050. Psychological factors are increasingly recognised as important predictors of healthy aging. While there are a growing number of studies examining resilience in different populations, there is a paucity of literature examining psychological resilience in individuals with hip fractures.

Objectives:

We aim to identify the association between high psychological resilience and improved functional outcomes in post-operative hip fracture patients in a Singapore Community Hospital, defined by a Conner-Davidson Resilience Scale 25 (CD-RISC 25) score of 62 and above.

Methods:

We conducted a pilot prospective cohort study in Bright Vision Community Hospital in Singapore. Post-operative elderly hip fracture patients were invited to participate in the study. Psychological resilience scores were measured on Day 1 of admission using CD-RISC 25. Functional outcomes were then tracked weekly for 21 days while participants underwent rehabilitation using the Modified Barthel Index (MBI).

Results:

High psychological resilience was found in 52.40% of the post-operative hip fracture participants in this study. Of those participants with high psychological resilience, 55% achieved functional independence ( n = 11), compared with 47.47% of participants with low psychological resilience ( n = 9) – although this result did not achieve statistical significance.

Conclusion:

One in two post-operative hip fracture patients had high psychological resilience, and our study suggests that patients with high psychological resilience can possibly achieve higher gains in functional scores and achieve functional independence.

Holistic Management of Older Patients With Hip Fractures

As the silver tsunami hits the world, older patients with hip fractures are expected to increase to 6.3 million by the year 2050, of which the majority will occur in Asia. The estimated global cost of hip fractures in the year 2050 is estimated to reach U.S. $130 billion. Hence, in addition to implementation of prevention strategies, it is important to develop an optimal model of care for older patients with hip fracture to minimize the huge medical and socioeconomic burden, especially in rapidly aging nations. This review summarizes the complications of hip fractures, importance of comprehensive geriatric assessment, and multidisciplinary rehabilitation, as well as predictors of rehabilitation outcome in older patients with hip fracture.