Identifying High-Care-Need Phenotypes After Hip Fracture Surgery Using Nursing-Actionable Registry Variables

Background: Older adults undergoing hip fracture surgery may differ substantially from one another in baseline function, cognitive status, living situation, and perioperative risk. Such differences can complicate patients’ needs postoperatively. Purposes: This study aimed to identify clinically-usable postoperative care-need phenotypes among older adults undergoing hip fracture surgery. Methods: This retrospective cohort study used data from the national registry-based UK National Hip Fracture Database to identify 63 108 older adults who underwent hip fracture surgery between 2016 and 2021. Nursing-actionable variables, including age, pre-fracture residence, pre-fracture mobility, cognitive impairment or dementia, and American Society of Anesthesiologists (ASA) grade, were used to identify clinically-interpretable care-need phenotypes: low-care-need, mobility-limited, and cognitive-institutional high-care-need. The primary outcome was failure to return home after hip fracture surgery, which reflects the combined effects of functional recovery, care dependency, rehabilitation need, and discharge planning. Results: Using data from the 63 108 patients included, phenotypes were categorized: low-care-need (n = 25 842; 41.0%), mobility-limited (n = 22 671; 35.9%), and cognitive-institutional high-care-need (n = 14 595; 23.1%). Failure to return home increased from 18.4% in the low-care-need phenotype to 39.5% in the mobility-limited phenotype and 73.8% in the cognitive-institutional high-care-need phenotype. The mobility-limited and cognitive-institutional high-care-need phenotypes were also associated with higher adjusted odds of prolonged length of stay of over 21 days, discharge to residential or nursing care, and 30 day mortality. Conclusion: This retrospective database analysis found that identified distinct postoperative care-need phenotypes for older adults after hip fracture surgery. These phenotypes were strongly associated with failure to return home, prolonged hospitalization, institutional care, and mortality. Such risk stratification may help nursing teams and multidisciplinary hip fracture services align rehabilitation, discharge planning, and post-acute care coordination with patient-level recovery needs. Level of Evidence: Prognostic study level III.