Rehabilitation Settings for Hip Fracture Repair in Veterans

Surgeons who care for war-injured and aging soldiers at US Department of Veterans Affairs (VA) hospitals perform several thousands of hip surgeries each year.

Since VA clinicians are concerned that their hip fracture patients will not return to their preoperative functional levels, many wonder if particular types of rehabilitation can improve postoperative outcomes. Currently, veterans who undergo hip fracture repair can be discharged to one of several rehabilitation settings.

A retrospective study published in the Journal of Rehabilitation Research & Development examines the patient, facility, and market factors that influence postsurgical discharge settings for specific veterans. Using data from the VA National Surgical Quality Improvement Program, the authors reviewed 7 years of records on 11,083 veterans who underwent hip fracture surgeries in a VA hospital.

According to the researchers, roughly half of the veterans returned directly to their homes after surgery — a surprising finding, as only 9% of Medicare beneficiaries go straight home. Other often-used sites included nursing homes (15.4%), inpatient rehabilitation (16.9%), and outpatient rehabilitation (18.8%).

The factors that predicted the use of non-home settings for VA-provided rehabilitation included total function dependence, an American Society of Anesthesiologists (ASA) class 4 or 5 rating, surgical complications prior to discharge, or residence in a county with lower nursing home bed occupancy rates.

Overall, surgical complications had the strongest association with discharge to inpatient care, and the researchers discovered the most vulnerable veterans were often sent to inpatient facilities.