[Early interdisciplinary geriatric rehabilitation after hip fracture : Effective concept or just transfer of costs?].
BACKGROUND
Modern strategies for postoperative care of patients with hip fractures include early discharge from the acute care hospital to inpatient interdisciplinary rehabilitation facilities. Whether these programs are effective for the patients and improve their long-term outcomes or if they simply transfer costs, with a reduction of the inpatient days in the acute care hospital, is currently under discussion.


METHODS
This prospective study included 282 patients with hip fracture admitted to our trauma center were included into the prospective study. The mean patient age was 86+/-8 (65-110) years. All patients were treated operatively. After a mean of 12+/-9 days, the patients underwent inpatient interdisciplinary geriatric rehabilitation for a mean of 27+/-13 (4-103) days. The primary outcome measure was their activities of daily living (Barthel index) before, at the end of rehabilitation, and 1 year after trauma. In addition, patient-related variables were correlated with the Barthel index.


RESULTS
With discharge from the acute care hospital, the Barthel index was 42+/-20 points and it increased during rehabilitation to 65+/-26 points. One year later the Barthel index was 67+/-28 points. Ninety percent of patients improved their Barthel index during rehabilitation. Within 1 year, 40% of patients deteriorated in their activities of daily living. Fifty one percent of patients were reintegrated back to their homes. Patients who lived at home before trauma and were reintegrated back to their homes had a significant higher Barthel index (75+/-24) 1 year after trauma than patients who were living in a nursing care facility before the trauma (Barthel index 52+/-27). The variables of age, level of cognition, and type of fracture had no influence on the long-term outcome. An extension of rehabilitation above the mean time period did not improve the sustainable clinical outcome.


CONCLUSIONS
Postoperative inpatient rehabilitation programs enhance short-term activities of daily living. In particular, patients who lived at home before the trauma and were reintegrated back home benefited in perpetuity from geriatric rehabilitation. A policy for early discharge to geriatric rehabilitation is associated with extension of overall hospital stay. This association along with the related increased health care costs should be weighed against the sociofunctional effectiveness of these programs.
Lögters
T
T
Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland. Tim.Loegters@uni-duesseldorf.de
Hakimi
M
M
Linhart
W
W
Kaiser
T
T
Briem
D
D
Rueger
J
J
Windolf
J
J
D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D003361:Cost Allocation; D005260:Female; D005265:Femoral Neck Fractures / Q000191:economics / Q000534:rehabilitation*; D005500:Follow-Up Studies; D005858:Germany; D006620:Hip Fractures / Q000191:economics* / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000191:economics*; D026741:Physical Therapy Modalities / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics / Q000534:rehabilitation; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000191:economics