Implications of COVID-19 on hip fracture care discharge locations during the early stages of the pandemic

OBJECTIVES: To document discharge locations for geriatric patients treated for a hip fracture before and during the COVID pandemic and subsequent changes in outcomes seen between each cohort. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENTS/PARTICIPANTS: Two matched cohorts of 100 patients with hip fracture treated pre-COVID (February–May 2019) and during COVID (February–May 2020). INTERVENTION: Discharge location and COVID status on admission. Discharge locations were home (home independently or home with health services) versus facility [subacute nursing facility (SNF) or acute rehabilitation facility]. MAIN OUTCOME MEASUREMENTS: Readmissions, inpatient and 1-year mortality, and 1-year functional outcomes (EQ5D-3L). RESULTS: In COVID+ patients, 93% (13/14) were discharged to a facility, 62% (8/13) of whom passed away within 1 year of discharge. Of COVID+ patients discharged to an SNF, 80% (8/10) died within 1 year. Patients discharged to an SNF in 2020 were 1.8x more likely to die within 1 year compared with 2019 (P = 0.029). COVID− patients discharged to an SNF in 2020 had a 3x increased 30-day mortality rate and 1.5x increased 1-year mortality rate compared with 2019. Patients discharged to an acute rehabilitation facility in 2020 had higher rates of 90-day readmission. There was no difference in functional outcomes. CONCLUSIONS: All patients, including COVID− patients, discharged to all discharge locations during the onset of the pandemic experienced a higher mortality rate as compared with prepandemic. This was most pronounced in patients discharged to a skilled nursing facility in 2020 during the early stages of the pandemic. If this trend continues, it suggests that during COVID waves, discharge planning should be conducted with the understanding that no options eliminate the increased risks associated with the pandemic. LEVEL OF EVIDENCE: III