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Hip fracture patients with osteoarthritis have longer hospital stays, but similar functional gain as those without the condition

Elderly hip fracture patients with osteoarthritis (OA) have longer hospital stays for rehabilitation than patients without OA. However, they have similar weekly gains in function from in-hospital rehabilitation, and a similar percentage are discharged home rather than to another facility, according to a new study. The longer hospital stay for patients with OA probably resulted in equitable functional recovery at followup.

Researchers analyzed outcomes of 1,953 elderly hip fracture patients with OA and 11,441 elderly hip fracture patients without OA, who were hospitalized from 1994 to 2001. Mean length of stay for patients with OA was 18.1 days versus 16.5 days for those without OA. After adjusting for age, sex, race/ethnicity, coexisting conditions, Functional Independence Measure (FIM) ratings at hospital admission (for example, cognition, ability to walk and climb stairs, and ability to engage in self-care activities), and total hip replacement, OA was associated with a 1.4 day longer rehabilitation stay and slightly higher discharge FIM ratings.

However, OA was not associated with lower weekly rehabilitation gain (mean weekly gain of 11.8 for those with OA vs. 11.9 for those without OA), followup FIM ratings, and discharge home.

The researchers note that these hospitalizations for hip fracture took place during the fee-for-service payment system prior to the 2002 implementation of the Medicare Prospective Payment System (PPS). Under PPS, hip fracture patients with OA are more likely to be discharged before they are fully functional, because PPS pays for the same length of stay for patients with or without OA. Their study was supported in part by the Agency for Healthcare Research and Quality (HS11618).

See "Impact of osteoarthritis on rehabilitation for persons with hip fracture," by Tracy U. Nguyen-Oghalai, M.D., Kenneth J. Ottenbacher, Ph.D., Carl V. Granger, M.D., and others, in the December 15, 2006, Arthritis & Rheumatism 55(6), pp. 920-924.

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