DR FOSTER DATA FOR MORTALITY RATE IN FRACTURE NECK OF FEMUR PATIENTS – IS IT RELIABLE?

Abstract

Introduction: Dr Foster data presents mortality rate for fracture neck of femur in acute trusts. We assessed the accuracy of this data in an acute trust in England for a nine-month period.

Methods: Fifty-seven patients (17.2%) died due to fracture NOF during our review period according to Dr Foster. Medical notes were retrospectively analysed in detail. There were 20 males with a mean age of 84.5yrs (64–100) and 37 females with a mean age of 85.7yrs (57–100). Data analysis included time and day of admission, admission ward, senior orthopaedic review, anaesthetic review, ASA grade, time to surgery, grade of anaesthetist and operating surgeon, type of anaesthesia, time of anaesthesia and surgery, type of surgery, post-op recovery and cause of death.

Results: Seven patients died before their planned surgery due to extensive medical co-morbidity and 50 patients (15.1%) underwent surgery as planned. Thirty-one patients (9.4%) died under the care of the orthopaedic team and were considered by the assessors to be true death due to fracture neck of femur. Eleven patients (3.3%) died in the community after discharge home some several months later. Eight patients (2.4%) died under the care of the rehabilitation team, some months later, the majority from medical causes. The mean time to surgery was 2.7 days (0–13), which was mainly affected by weekend admissions. There were no records of the cause of death in 20 patients including all those that were discharged to the community. Admission time, ward and type and duration of anaesthesia had no effect on mortality rate.

Conclusion: In our review Dr Foster overestimated true death rate due to fracture neck of femur. This trend is worrying as such indicators are linked to financial and performance targets for trusts. Accurate data presentation is therefore imperative and Dr Foster does not appear to deliver this.