A Prospective Study on the Incidence of Postoperative Complications in Hip Fracture Patients Receiving Postacute Care
TL;DR
Elderly hip fracture patients discharged home demonstrated functional recovery and complication rates comparable to those receiving intensive inpatient PAC, suggesting that with adequate home-based support, direct discharge is a clinically noninferior alternative to inpatient care.
Abstract
Taiwan’s postacute care (PAC) program was designed to enhance outcomes for patients with fragility fractures. However, the subsequent launch of the comprehensive Long-Term Care 2.0 (LTC 2.0) program, which offers robust home-based services, raises questions about the relative benefit of inpatient PAC. This study aimed to compare functional recovery and complication rates in elderly patients with hip fractures who either participated in an inpatient PAC program or were discharged home with access to LTC 2.0. This prospective cohort study enrolled patients aged ≥65 years who underwent hip fracture surgery. Based on patient and family preferences, participants were allocated to either an inpatient PAC program ( n = 34) or direct discharge home ( n = 45). Functional outcomes were assessed at five time points over 1 year using the Barthel index and Harris hip score. Generalized estimating equations (GEEs) were used to model recovery trajectories, and complications, readmissions, and mortality were tracked. Both the groups showed significant functional improvement over time ( P < 0.001). However, GEE analysis revealed no significant between-group differences in the recovery trajectories for daily living activities ( P = 0.393) or hip function ( P = 0.638) at 1 year. Advanced age and a higher Charlson comorbidity index score were identified as significant negative predictors of recovery, whereas male sex was associated with better functional outcomes. There were no significant differences in overall complication rates, emergency visits, readmissions, or 1-year mortality between the two groups. In the context of Taiwan’s comprehensive LTC 2.0 program, elderly hip fracture patients discharged home demonstrated functional recovery and complication rates comparable to those receiving intensive inpatient PAC. This suggests that with adequate home-based support, direct discharge is a clinically noninferior alternative to inpatient care. While PAC offers an early intensive intervention, home-based care facilitates real-world adaptation, allowing for effective recovery in suitable candidates.