Risk Factors for Readmission Following Elderly Low Energy Pelvis Fractures.

Abstract

Introduction: Fragility fractures of the pelvis (FFP) are associated with loss of mobility and significant mortality in elderly patients. The purpose of this study was to assess the 60-day readmission rates following FFP and to identify what factors may predict readmission.

Methods: Six hundred thirty-one patients over 65 years of age presenting for FFP to a level 1 trauma center between 2010 and 2022 were reviewed. The chi-square test of independence and logistic regression were performed to identify factors associated with readmission.

Results: One hundred and thirty-six patients met inclusion criteria. Of these, 31 (23%) returned to the Emergency Department (ED) within 60 days of discharge and 16 (12%) were readmitted. Chronic obstructive pulmonary disease (COPD) (OR = 3.30, P = .01), discharge home instead of to a skilled nursing facility (SNF) (OR = 2.75, P = .01), discharge home from the ED instead of admission to the hospital (OR = 2.95, P = .009), and an American Society of Anesthesiologists (ASA) score ≥4 (OR = 5.14, P = .03) were all associated with return to the ED. Patients who were able to ambulate in the ED were less likely to be admitted to the hospital (OR = 0.05, P < .001) and more likely to return to the ED within 60 days (OR = 4.52, P = .03).

Conclusion: Return to the ED and readmission following FFP is common, with an incidence of 23% and 12% in our cohort. Patients who were not admitted as an inpatient after their initial presentation, and patients who were discharged home instead of to a SNF, both had a higher risk of repeat presentation within 60 days of discharge. Additionally, ambulation by patients in the ED may provide false reassurance, as these patients were less likely to be admitted as an inpatient, but more likely to subsequently return within 60 days.