Implementation status of postoperative rehabilitation for older patients with hip fracture in Kyoto City, Japan: A population-based study using medical and long-term care insurance claims data

Continuing rehabilitation after hip fractures is recommended to improve physical function and quality of life. However, the long-term implementation status of postoperative rehabilitation is unclear. This study aims to investigate the implementation status of postoperative rehabilitation for older patients with hip fractures and the factors associated with continuing rehabilitation. A retrospective cohort study evaluated medical and long-term care insurance claims data of patients aged 75 years or older in Kyoto City, Japan, who underwent hip fracture surgeries from April 2013 to October 2018. We used logistic regression analysis to examine factors associated with six-month rehabilitation continuation. Of the 8,108 participants, 8,037 (99%) underwent rehabilitation the first month after surgery, but only 1,755 (22%) continued for six months. The following variables were positively associated with continuing rehabilitation for six months: males (adjusted odds ratio: 1.41 [95% confidence interval: 1.23–1.62]), an intermediate frailty risk (1.50 [1.24–1.82]), high frailty risk (2.09 [1.69–2.58]) estimated using the hospital frailty risk scores, and preoperative care dependency levels: support level 1 (1.69 [1.28–2.23]), support level 2 (2.34 [1.88–2.90]), care-need level 1 (2.04 [1.68–2.49]), care-need level 2 (2.42 [2.04–2.89]), care-need level 3 (1.45 [1.19–1.76]), care-need level 4 (1.40 [1.12–1.75]), and care-need level 5 (1.31 [0.93–1.85]). In contrast, dementia was cited as a disincentive (0.53 [0.45–0.59]). Less than 30% of older patients continued rehabilitation for six months after surgery. Factors associated with continuing rehabilitation were male sex, higher frailty risk, care dependency before hip fracture surgeries, and non-dementia.