Effect of Obesity on Postacute Outcomes of Skilled Nursing Facility Residents with Hip Fracture

Objectives To examine the effect of obesity (body mass index (BMI)≥30.0 kg/m2) on outcomes of older adults admitted to skilled nursing facilities (SNFs) for hip fracture postacute care (PAC). Design Retrospective cohort study. Setting U.S. Medicare‐ and Medicaid‐certified SNFs from 2008 to 2015. Participants Medicare fee‐for‐service beneficiaries discharged to a SNF after hospitalization for hip fracture (N=586,683; n=82,768 (14.1%) meeting obesity criteria). Exclusion criteria were aged younger than 65, being underweight (BMI100) according to obesity level. Models were adjusted for individual‐level covariates and facility fixed effects. Results Residents with mild (adjusted relative risk (aRR)=1.16, 95% CI=1.12–1.19), moderate (aRR=1.27, 95% CI=1.20–1.35), and severe (aRR=1.67, 95% CI=1.54–1.82) obesity were more likely to be readmitted within 30 days than those who were not obese. The average difference in LOS between residents without obesity and those with mild obesity was 2.6 days (95% CI=2.2–2.9 days); moderate obesity, 4.2 days (95% CI=3.7–5.1 days); and severe obesity, 7.0 days (95% CI=5.9–8.2 days). Residents with obesity were less likely to be successfully discharged and more likely to become long‐stay nursing home residents. Conclusion Obesity was associated with worse outcomes in postacute SNF residents with hip fracture. Efforts to provide targeted care to residents with obesity may be essential to improve outcomes. Obesity may be an overlooked risk adjuster in quality‐of‐care measures and in payment reforms related to PAC for individuals with hip fracture.