Predictors of change in ‘discharge destination’ following treatment for fracture neck of femur Shashi Kumar Nanjayan *, Joby John, Girish Swamy, Konstantinos Mitsiou, Amol Tambe, Tarek Abuzakuk Department of Trauma & Orthopaedics, Royal Derby Hospital, Derby DE22 3NE, UK Introduction Fracture of the neck of femur is a significant injury in the elderly population. A common reason for admission to an orthopaedic trauma ward, it is a life changing event for the patient and has a major impact on health economics [1]. Demographic projections predict an estimated increase in the incidence and annual expenditure that could reach £2.2 billion by 2020 in the United Kingdom [1]. It is hence not surprising that care provided to the patients with fracture neck of femur is a topic of national debate and scrutiny. Following a fracture neck of femur, many patients are unable to regain their pre-fracture status of mobility and daily activities [2]. As a result some are not able to return to their pre injury residential status in-spite of surgery and adequate rehabilitation. Hence, they may require institutional care for the rest of their life. Less than 60% of these patients return to their own place of residence [3] and even fewer reach their pre-injury ambulatory status [4]. Inability to Injury, Int. J. Care Injured xxx (2014) xxx–xxx A R T I C L E I N F O Article history: Received 17 October 2013 Received in revised form 28 January 2014 Accepted 2 February 2014 Keywords: Discharge destination Fracture neck of femur A B S T R A C T Objectives: 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. Materials and 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: (1) living in their own home; (2) residential home; (3) nursing home; (4) hospitalised. 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 36 h 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 36 h for medical reasons (OR = 4.38) were predictors of the change in discharge destination. Conclusion: 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. ß 2014 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +44 790 3383 779. E-mail address: shashikumartn@gmail.com (S.K. Nanjayan). G Model JINJ-5637; No. of Pages 5 Please cite this article in press as: Nanjayan SK, et al. Predictors of change in ‘discharge destination’ following treatment for fracture neck of femur. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.02.005 Contents lists available at ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y http://dx.doi.org/10.1016/j.injury.2014.02.005 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.