title: Predictors of change in 'discharge destination' following treatment for fracture neck of femur.
abstract: OBJECTIVE
  The purpose of our study was to analyse the incidence and factors predicting the 'change in discharge destination' in patients with fractured neck of femur who were treated surgically.
  
  
  METHODS
  Fifteen hundred and seventy-three consecutive patients admitted with a fractured neck of femur, residing in their own home prior to admission were studied. Patients who did not have an operation (n=70) for their hip fracture were excluded from the study. Residential location in the UK is broadly categorised as:
  
  
  RESULTS
  A downward drift in "discharge destination" of 20% was noted after analysis. Univariate analysis revealed that age, gender, AMT score, place of fall, type of fracture, walking ability outdoor and indoor, ASA grade, medical co-morbidity requiring physician review and delay beyond 36h to surgery had a significant effect. Multiple logistic regression analysis revealed that increasing age, male gender (OR=1.67), accompaniment for outdoor mobilisation (OR=1.96), increasing ASA grade, AMT score <6 (OR=4.86), pre-operative medical condition requiring physician review (OR=2.27), delay greater than 36h for medical reasons (OR=4.38) were predictors of the change in discharge destination.
  
  
  CONCLUSIONS
  The most important predictors of the change in the discharge destination were the medical condition, cognitive and physical function of the patient at admission. Male gender and increasing age were contributory. The only clinician dependent factor that seemed to affect this change of residential status was delay to surgery secondary to medical problems. Awareness of key predictors that affect the "discharge destination" can be useful for the multidisciplinary team and patients' families to evaluate and plan for an early, satisfactory and appropriate referral to either community services or institutional care, which in turn could have a significant socioeconomic impact.
authors.affiliation: Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK. Electronic address: shashikumartn@gmail.com.
authors.forename: Shashi Kumar
authors.initials: SK
authors.lastname: Nanjayan
authors.affiliation: Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK.
authors.forename: Joby
authors.initials: J
authors.lastname: John
authors.affiliation: Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK.
authors.forename: Girish
authors.initials: G
authors.lastname: Swamy
authors.affiliation: Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Mitsiou
authors.affiliation: Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK.
authors.forename: Amol
authors.initials: A
authors.lastname: Tambe
authors.affiliation: Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK.
authors.forename: Tarek
authors.initials: T
authors.lastname: Abuzakuk
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D003668:Pressure Ulcer / Q000453:epidemiology*; D012047:Rehabilitation Centers; D012737:Sex Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Discharge destination; Fracture neck of femur