The aim of this study was to determine the impact of hospital-level service characteristics on hip fracture outcomes and quality of care processes measures. This was a retrospective analysis of publicly available audit data obtained from the National Hip Fracture Database (NHFD) 2018 benchmark summary and Facilities Survey. Data extraction was performed using a dedicated proforma to identify relevant hospital-level care process and outcome variables for inclusion. The primary outcome measure was adjusted 30-day mortality rate. A random forest-based multivariate imputation by chained equation (MICE) algorithm was used for missing value imputation. Univariable analysis for each hospital level factor was performed using a combination of Tobit regression, Siegal non-parametric linear regression, and Mann-Whitney U test analyses, dependent on the data type. In all analyses, a p-value < 0.05 denoted statistical significance.Aims
Methods
Aims. We present an audit comparing our level I major trauma centre’s
data for a cohort of patients with hip fractures in the National
Hip Fracture Database (NHFD) with locally held data on these patients. Patients and Methods. A total of 2036 records for episodes between July 2009 and June
2014 were reviewed. . Results. The demographics of nine patients were recorded incorrectly.
The rate of incorrect data in operation codes was most significant
with overall accuracy of 0.637 (95% CI 0.615 to 0.658). The sensitivity
of
Aims. This study explores data quality in operation type and fracture classification recorded as part of a large research study and a national audit with an independent review. Patients and Methods. At 17 centres, an expert surgeon reviewed a randomly selected subset of cases from their centre with regard to fracture classification using the AO system and type of operation performed. Agreement for these variables was then compared with the data collected during conduct of the World Hip Trauma Evaluation (WHiTE) cohort study. Both types of surgery and fracture classification were collapsed to identify the level of detail of reporting that achieved meaningful agreement. In the National Hip Fracture Database (NHFD), the types of operation and fracture classification were explored to identify the proportion of “highly improbable” combinations. Results. The records were reviewed for 903 cases. Agreement for the subtypes of extracapsular fracture was poor; most centres achieved no better than “fair” agreement. When the classification was collapsed to a single option for “extracapsular” fracture, only four centres failed to have at least “moderate” agreement. There was only “moderate” agreement for the subtypes of intracapsular fracture, which improved to “substantial” when collapsed to “intracapsular”. Subtrochanteric fracture types were well reported with “substantial” agreement. There was near “perfect” agreement for internal fixation procedures. “Perfect” or “substantial” agreement was achieved when the type of arthroplasty surgery was reported at the level of “hemiarthroplasty” and “total hip replacement”. When reviewing data submitted to the
Aims. This study sought to determine the proportion of older adults with hip fractures captured by a multicentre prospective cohort, the World Hip Trauma Evaluation (WHiTE), whether there was evidence of selection bias during WHiTE recruitment, and the extent to which the WHiTE cohort is representative of the broader population of older adults with hip fractures. Patients and Methods. The characteristics of patients recruited into the WHiTE cohort study were compared with those treated at WHiTE hospitals during the same timeframe and submitted to the National Hip Fracture Database (NHFD). Results. Patients recruited to WHiTE were more likely to be admitted from their own home (83.5% vs 80.2%; p < 0.001) and to have a higher median Abbreviated Mental Test Score (AMTS) (9 (interquartile range (IQR) 6 to 10) vs 9 (IQR 5 to 10); p < 0.001) than those who were not recruited. In terms of WHiTE cohort generalizability, participating hospitals included a greater proportion of Major Trauma Centres (47.8% vs 7.8%) and large hospitals (997 (IQR 873 to 1290) vs 707 (459 to 903) beds) with high-volume Emergency Departments (median annual attendances of 43 981 (IQR 37 147 to 54 385) vs 35 964 (IQR 26 229 to 50 551)). However, there were few differences in baseline characteristics between patients in the WHiTE cohort and those recorded in the
Hip fracture commonly affects the frailest patients, of whom many are care-dependent, with a disproportionate risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England. We conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1 February 2019 and 31 October 2020 in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England’s SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models.Aims
Methods
The purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland. The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a fragility fracture of the lower limb between 1 January 2019 and 30 June 2019, and 1 February 2021 and 14 March 2021. Fractures arising from high-energy transfer trauma, patients with multiple injuries, and those associated with metastatic deposits or infection were excluded. We analyzed this patient cohort to determine adherence to the British Orthopaedic Association Standard, “all surgery in the frail patient should be performed to allow full weight-bearing for activities required for daily livingAims
Methods
To compare the cost-effectiveness of high-dose, dual-antibiotic cement versus single-antibiotic cement for the treatment of displaced intracapsular hip fractures in older adults. Using data from a multicentre randomized controlled trial (World Hip Trauma Evaluation 8 (WHiTE-8)) in the UK, a within-trial economic evaluation was conducted. Resource usage was measured over 120 days post randomization, and cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY), gained from the UK NHS and personal social services (PSS) perspective in the base-case analysis. Methodological uncertainty was addressed using sensitivity analysis, while decision uncertainty was handled using confidence ellipses and cost-effectiveness acceptability curves.Aims
Methods
Prior to the availability of vaccines, mortality for hip fracture patients with concomitant COVID-19 infection was three times higher than pre-pandemic rates. The primary aim of this study was to determine the 30-day mortality rate of hip fracture patients in the post-vaccine era. A multicentre observational study was carried out at 19 NHS Trusts in England. The study period for the data collection was 1 February 2021 until 28 February 2022, with mortality tracing until 28 March 2022. Data collection included demographic details, data points to calculate the Nottingham Hip Fracture Score, COVID-19 status, 30-day mortality, and vaccination status.Aims
Methods
The aim of this study to compare 30-day survival and recovery of mobility between patients mobilized early (on the day of, or day after surgery for a hip fracture) and patients mobilized late (two days or more after surgery), and to determine whether the presence of dementia influences the association between the timing of mobilization, 30-day survival, and recovery. Analysis of the National Hip Fracture Database and hospital records for 126,897 patients aged ≥ 60 years who underwent surgery for a hip fracture in England and Wales between 2014 and 2016. Using logistic regression, we adjusted for covariates with a propensity score to estimate the association between the timing of mobilization, survival, and recovery of walking ability.Aims
Methods
Patients who sustain neck of femur fractures are at high risk of malnutrition. Our intention was to assess to what extent malnutrition was associated with worse patient outcomes. A total of 1,199 patients with femoral neck fractures presented to a large UK teaching hospital over a three-year period. All patients had nutritional assessments performed using the Malnutrition Universal Screening Tool (MUST). Malnutrition risk was compared to mortality, length of hospital stay, and discharge destination using logistic regression. Adjustments were made for covariates to identify whether malnutrition risk independently affected these outcomes.Aims
Methods
Hip fractures are associated with high morbidity, mortality, and costs. One strategy for improving outcomes is to incentivize hospitals to provide better quality of care. We aimed to determine whether a pay-for-performance initiative affected hip fracture outcomes in England by using Scotland, which did not participate in the scheme, as a control. We undertook an interrupted time series study with data from all patients aged more than 60 years with a hip fracture in England (2000 to 2018) using the Hospital Episode Statistics Admitted Patient Care (HES APC) data set linked to national death registrations. Difference-in-differences (DID) analysis incorporating equivalent data from the Scottish Morbidity Record was used to control for secular trends. The outcomes were 30-day and 365-day mortality, 30-day re-admission, time to operation, and acute length of stay.Aims
Materials and Methods
Bone health assessment and the prescription of medication for secondary fracture prevention have become an integral part of the acute management of patients with hip fracture. However, there is little evidence regarding compliance with prescription guidelines and subsequent adherence to medication in this patient group. The World Hip Trauma Evaluation (WHiTE) is a multicentre, prospective cohort of hip fracture patients in NHS hospitals in England and Wales. Patients aged 60 years and older who received operative treatment for a hip fracture were eligible for inclusion in WHiTE. The prescription of bone protection medications was recorded from participants’ discharge summaries, and participant-reported use of bone protection medications was recorded at 120 days following surgery.Aims
Patients and Methods
The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality. Data on 82 990 patients from the National Hip Fracture Database were analyzed using generalized linear models with incremental case-mix adjustment for patient, non-surgical and surgical characteristics, and socioeconomic factors.Aims
Patients and Methods
Hip fractures in patients < 60 years old currently account for only 3% to 4% of all hip fractures in England, but this proportion is increasing. Little is known about the longer-term patient-reported outcomes in this potentially more active population. The primary aim is to examine patient-reported outcomes following isolated hip fracture in patients aged < 60 years. The secondary aim is to determine an association between outcomes and different types of fracture pattern and/or treatment implants. All hip fracture patients aged 18 to 60 years admitted to a single centre over a 15-year period were used to identify the study group. Fracture pattern (undisplaced intracapsular, displaced intracapsular, and extracapsular) and type of operation (multiple cannulated hip screws, angular stable fixation, hemiarthroplasty, and total hip replacement) were recorded. The primary outcome measures were the Oxford Hip Score (OHS), the EuroQol five-dimension questionnaire (EQ-5D-3L), and EQ-visual analogue scale (VAS) scores. Preinjury scores were recorded by patient recall and postinjury scores were collected at a mean of 57 months (9 to 118) postinjury. Ethics approval was obtained prior to study commencement.Aims
Methods
We reviewed all patients who sustained a fracture of the hip
and were treated in Northern Ireland over a period of 15 years to
identify trends in incidence, the demographics of the patients,
the rates of mortality, the configuration of the fracture and the
choice of implant. Since 01 January 2001 data about every fracture of the hip sustained
in an adult have been collected centrally in Northern Ireland. All
adults with such a fracture between 2000 and 2015 were included
in the study. Temporal changes in their demographics, the mode of
treatment, and outcomes including mortality were analysed.Aims
Patients and Methods
Hip hemiarthroplasty is a standard treatment for intracapsular
proximal femoral fractures in the frail elderly. In this study we
have explored the implications of early return to theatre, within
30 days, on patient outcome following hip hemiarthroplasty. We retrospectively reviewed the hospital records of all hip hemiarthroplasties
performed in our unit between January 2010 and January 2015. Demographic
details, medical backround, details of the primary procedure, complications,
subsequent procedures requiring return to theatre, re-admissions,
discharge destination and death were collected.Aims
Patients and Methods
In this study, we aimed to determine whether designation as a
major trauma centre (MTC) affects the quality of care for patients
with a fracture of the hip. All patients in the United Kingdom National Hip Fracture Database,
between April 2010 and December 2013, were included. The indicators
of quality that were recorded included the time to arrival on an
orthopaedic ward, to review by a geriatrician, and to operation.
The clinical outcomes were the development of a pressure sore, discharge
home, length of stay, in-hospital mortality, and re-operation within
30 days. Aims
Patients and Methods
The Nottingham Hip Fracture Score (NHFS) was
developed to assess the risk of death following a fracture of the
hip, based on pre-operative patient characteristics. We performed
an independent validation of the NHFS, assessed the degree of geographical
variation that exists between different units within the United
Kingdom and attempted to define a NHFS level that is associated
with high risk of mortality. The NHFS was calculated retrospectively for consecutive patients
presenting with a fracture of the hip to two hospitals in England.
The observed 30-day mortality for each NHFS cohort was compared
with that predicted by the NHFS using the Hosmer–Lemeshow test.
The distribution of NHFS in the observed group was compared with
data from other hospitals in the United Kingdom. The proportion
of patients identified as high risk and the mortality within the
high risk group were assessed for groups defined using different
thresholds for the NHFS. In all 1079 hip fractures were included in the analysis, with
a mean age of 83 years (60 to 105), 284 (26%) male. Overall 30-day
mortality was 7.3%. The NHFS was a significant predictor of 30-day
mortality. Statistically significant differences in the distribution
of the NHFS were present between different units in England (p <
0.001). A NHFS ≥ 6 appears to be an appropriate cut-point to identify
patients at high risk of mortality following a fracture of the hip. Cite this article:
Hip fracture is a global public health problem.
The National Hip Fracture Database provides a framework for service evaluation
in this group of patients in the United Kingdom, but does not collect
patient-reported outcome data and is unable to provide meaningful
data about the recovery of quality of life. We report one-year patient-reported outcomes of a prospective
cohort of patients treated at a single major trauma centre in the
United Kingdom who sustained a hip fracture between January 2012
and March 2014. There was an initial marked decline in quality of life from baseline
measured using the EuroQol 5 Dimensions score (EQ-5D). It was followed
by a significant improvement to 120 days for all patients. Although
their quality of life improved during the year after the fracture,
it was still significantly lower than before injury irrespective
of age group or cognitive impairment (mean reduction EQ-5D 0.22;
95% confidence interval (CI) 0.17 to 0.26). There was strong evidence
that quality of life was lower for patients with cognitive impairment.
There was a mean reduction in EQ-5D of 0.28 (95% CI 0.22 to 0.35)
in patients <
80 years of age. This difference was consistent
(and fixed) throughout follow-up. Quality of life does not improve
significantly during recovery from hip fracture in patients over
80 years of age (p = 0.928). Secondary measures of function showed
similar trends. Hip fracture marks a step down in the quality of life of a patient:
it accounts for approximately 0.22 disability adjusted life years
in the first year after fracture. This is equivalent to serious
neurological conditions for which extensive funding for research
and treatment is made available. Cite this article:
The aims of this study were to identify the early
in-hospital mortality rate after hip fracture, identify factors associated
with this mortality, and identify the cause of death in these patients.
A retrospective cohort study was performed on 4426 patients admitted
to our institution between the 1 January 2006 and 31 December 2013
with a hip fracture (1128 male (26%), mean age 82.0 years (60 to
105)). Admissions increased annually, but despite this 30-day mortality
decreased from 12.1% to 6.5%; 77% of these were in-hospital deaths.
Male gender (odds ratio (OR) 2.0, 95% confidence interval (CI) 1.3
to 3.0), increasing age (age ≥ 91; OR 4.1, 95% CI 1.4 to 12.2) and
comorbidity (American Society of Anesthesiologists grades 3 to 5;
OR 4.2, 95% CI 2.0 to 8.7) were independently and significantly
associated with increased odds of in-hospital mortality. From 220
post-mortem reports, the most common causes of death were respiratory
infections (35%), ischaemic heart disease (21%), and cardiac failure
(13%). A sub-group of hip fracture patients at highest risk of early
death can be identified with these risk factors, and the knowledge
of the causes of death can be used to inform service improvements
and the development of a more didactic care pathway, so that multidisciplinary
intervention can be focused for this sub-group in order to improve
their outcome. Cite this article:
