Abstract
The aim of the study was to assess the mortality associated with a hip fracture at 5 years in a geriatric population, and to evaluate the influence of age, cognitive state, mobility and residential status on long term survival after hip fracture.
This study forms part of a prospective audit of all patients with a hip fracture admitted to Queen's Medical Centre, Nottingham. Every patient has a detailed admission questionnaire completed including details of the injury, medical history, residence and mobility. All data is collected by independent audit personnel using a detailed proforma. Integration with the database of the Office for National Statistics ensured accurate mortality data for every patient in the study for at least 5 years. All patients admitted in a 2 year period were included and divided into two groups: group B (<80 yrs age, Abbreviated Mental Test score 7/10, admitted from own home, independently mobile) and group A (any patient who did not fulfil all of group B criteria). A multivariate analysis indicated these as important variables that predicted mortality. Exclusion criteria: pathological hip fracture or bilateral hip fractures.
1319 patients fitted the inclusion criteria. 1068 patients fulfilled criteria for group A, 251 patients for group B. Overall mortality was 71% at 5 years. The excess mortality for the first year was 43%. 151 patients (60%) of group B were still alive at 5 years in comparison with only 231 (22%) of group A. Increased survival was shown for each variable: independent mobility RR 2.34 (p<0.05), admitted from home RR 3.81 (p<0.05), age<80 years RR 3.95 (p<0.05) and AMT 7/10 RR 5.45 (p<0.05).
These results facilitate early recognition of those patients with an increased chance of long-term survival that may be suitable for surgical treatment, such as total hip replacement, which have a good long-term outcome.
