Admission to rehab increases risk of postoperative venous thromboembolism and bleeding after operative fixation of femoral neck fractures

Aims & objectives: The risk of postoperative venous thromboembolism (VTE) and bleeding after operative management of femoral neck fractures (FNF) is well established. It is common for FNF patients to be discharged to rehabilitation facilities, despite higher complication rates. It was hypothesized that discharge to rehabilitation after operative fixation of FNF was associated with increased risk of VTE and bleeding. Materials & methods: Retrospective review of 7483 patients who sustained FNF and underwent operative treatment between 1/1/2019-12/31/2021 was conducted using a commercial claims database. The primary outcome was VTE and bleeding post-discharge within 30 days of surgery. Risk factors for VTE and bleeding were evaluated by logistic regression analysis. Results: The cumulative incidence was 3.77 % (95 % confidence interval (CI) = 3.33-4.21) for VTE and 4.01 % (CI = 3.56-4.46) for bleeding. There were 56.7 % of patients who were discharged to rehabilitation. Multivariable analysis demonstrated hereditary hypercoagulable diagnosis (odds ratio (OR) = 2.86, CI = 1.33-6.16), discharge to rehabilitation (OR = 2.08, CI = 1.47-2.92), discharge to another location (OR = 1.94, CI = 1.15-3.27), and length of stay (LOS) >= 5 days (OR = 1.69, CI = 1.15-2.50) increased risk for postoperative VTE. Variables that increased risk of bleeding included discharge to rehabilitation (OR = 2.20, CI = 1.55-3.12), discharge to other (OR = 1.92, CI = 1.12-3.27), and chronic anticoagulation (OR = 1.58, CI = 1.19-2.10). Analysis of patients prescribed thromboprophylactic medications demonstrated cumulative incidence of VTE 3.46 % (CI = 2.24-4.68) and 4.47 % (CI = 3.09-5.85) for bleeding at 30 days. Conclusion: In patients with FNF, discharge to inpatient rehabilitation was associated with increased risk of postoperative VTE and bleeding. LOS >= 5 days was also associated with increased VTE risk, demonstrating the importance of timely hospital discharge.