Mekkawy et al reported factors predictive of discharge to hospice following surgical fixation of a hip fracture. Discharge to hospice is associated with a high 30-day mortality. The authors are from Johns Hopkins University, Washington Orthopaedics & Sports Medicine, University of Rochester, Stanford University, and Philadelphia College of Osteopathic Medicine.
Patient selection: older adult with hip fracture
Outcome: discharge to hospice
Frequency of outcome: 0.9%
Most important predictors:
(1) disseminated cancer (OR 6.1)
(2) functional status totally dependent (OR 3.8)
(3) preoperative 6-month weight loss > 10% (OR 2.6)
(4) preoperative cognitive deficit (OR 2.0)
Liver disease with ascites had an odds ratio of 2.8 but the p value was 0.066.
Other predictors with OR from 1.5 to 1.99:
(1) delay > 48 hour between admission and surgery (OR 1.5)
(2) functional status partial dependence (OR 1.8)
(3) history of congestive heart failure (OR 1.8)
(4) full medical co-management required (OR 1.9)
(5) preoperative sepsis (OR 1.8)
