Each year, 70-75,000 older people suffer a hip fracture that requires surgery in the UK. These hip fracture patients have a high risk of in-hospital mortality – a risk that clearly exceeds that of elective total hip replacement even accounting for differences in age, sex and comorbidity.
More insight on how best to provide care for patients with hip fracture is therefore warranted. Our study in Age and Ageing shows that admission to an orthogeriatric unit was associated with lower short term mortality and higher quality of care compared to an admission to a traditional orthopaedic department. All hip fracture patients appeared to benefit from admission to an orthogeriatric unit as the lower mortality rates were shown to be lower in all examined subgroups of patients independent of the patient risk profile.
Correlation between quality and mortality
In the study, we examined mortality after 30 days, quality of care, time for surgery and length of stay in hospital. The study included all hip fracture patients in Denmark from 2010 to 2011. Patients were classified according to whether they had been admitted to an orthogeriatric unit with daily multidisciplinary care with involvement of both orthopaedic surgeons and geriatricians or a traditional orthopaedic department with medical consultant service only on request.
The quality of treatment was measured according to whether the patient received daily pain assessment, mobilisation within 24 hours of the operation, assessment of their functional level, preparation of a rehabilitation plan and implementation of preventive measures relating to falls and osteoporosis.
Overall, the patients in the orthogeriatric units were most likely to receive care according to recommendations. Patients admitted to an orthogeriatric unit had a higher chance of fulfilling five out of six quality criteria compared to patients admitted to a traditional orthopaedic department. The differences in quality of care appeared to explain, in part, the lower mortality in the orthogeriatric units.
Waiting time for surgery and length of hospital stay were independent of the unit setting.
Facts about the study
- 11,461 patients in Denmark with hip fractures sustained in the period 1 March 2010 to 30 November 2011 were included in the study.
- All of the patients were 65 years old or older.
- For patients admitted to an orthogeriatric unit, the 30-day mortality rate was 9.4 per cent, while the mortality rate was 12.0 per cent for patients admitted to traditional orthopaedic departments. The association remained after adjustment for a range of well-established prognostics factors for death.
- The study was based on data from the Danish Multidisciplinary Hip Fracture Registry, which on a routine basic collected detailed data on quality of care on all patients admitted with hip fracture in Denmark, which makes it possible to compare the quality of care offered at the orthopaedic and orthogeriatric units.