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Geographical variation in surgical care and mortality following hip fracture in England: a cohort study using the National Hip Fracture Database (NHFD)

Geographical variation in surgical care and mortality following hip fracture in England: a cohort study using the National Hip Fracture Database (NHFD)
Geographical variation in surgical care and mortality following hip fracture in England: a cohort study using the National Hip Fracture Database (NHFD)
Summary: we describe variation across geographical regions of England in operations undertaken following presentation of hip fracture and in 30-day mortality. Some significant geographic variation in 30-day mortality was observed particularly for patients with trochanteric hip fractures and warrants further investigation of other aspects of post-hip fracture care

Introduction: mortality after hip fracture has improved considerably in the UK over recent decades. Our aim here was to describe geographical variation in type of operation performed and 30-day mortality amongst patients in England with hip fracture.

Methods: the National Hip Fracture Database was used to carry out a prospective cohort study of nearly all over-60 year olds with hip fracture in England. These data were linked to Hospital Episode Statistics (HES), allowing us to explore regional variation in the operations performed for three fracture types (intracapsular, trochanteric and subtrochanteric), and use logistic regression models adjusted for demographic and clinical factors to describe associated 30-day mortality.

Results: NHFD recorded data for 64,211 patients who underwent surgery in England during 2017. Most had an intracapsular (59%) or trochanteric fracture (35%), and we found significant geographical variation across regions of England in use of total hip replacement (THR) (ranging from 10.1 to 17.4%) for intracapsular fracture and in intermedullary nailing (ranging from 14.9 to 27.0%) of trochanteric fracture. Some geographical variation in mortality amongst intracapsular fracture patients was found, with slightly higher mortality in the East of England (adjusted odds ratio [aOR]: 1.22, 95% CI: 1.02–1.46). Trochanteric fractures showed slightly more variation, with higher 30-day mortality (aOR: 1.40, 95%CI: 1.05–1.88) in the East of England and significantly lower mortality in the North East (aOR: 0.65, 95%CI: 0.46–0.93).

Conclusions: we have identified regional differences in operation type and 30-day mortality amongst hip fracture patients in England. The relationship between surgical approach and mortality has been explored, but the extent to which differential mortality reflects variation in approach to medical assessment, anaesthesia and other aspects of care warrants further investigation.
Epidemiology, Geographical variation, Hip fracture, Mortality, Surgery
0937-941X
1989-1998
Shah, Anjali
b981d8fd-a83d-43f5-926f-c6c0d8ec754d
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Inman, Dominic S
d23a8663-c4a9-46c4-b5b8-73878f5f4972
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Fagan, Elizabeth
6dc16226-6076-41b3-9876-ed7033944d97
Johansen, Antony
fde1a484-07de-4937-9834-9288671d1143
Judge, Andrew
53ccba98-13f0-4a06-b2ff-59a35616c990
Shah, Anjali
b981d8fd-a83d-43f5-926f-c6c0d8ec754d
Hawley, Samuel
407712ed-30ba-4458-a0f3-f6278e219845
Inman, Dominic S
d23a8663-c4a9-46c4-b5b8-73878f5f4972
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Fagan, Elizabeth
6dc16226-6076-41b3-9876-ed7033944d97
Johansen, Antony
fde1a484-07de-4937-9834-9288671d1143
Judge, Andrew
53ccba98-13f0-4a06-b2ff-59a35616c990

Shah, Anjali, Hawley, Samuel, Inman, Dominic S, Cooper, Cyrus, Fagan, Elizabeth, Johansen, Antony and Judge, Andrew (2021) Geographical variation in surgical care and mortality following hip fracture in England: a cohort study using the National Hip Fracture Database (NHFD). Osteoporosis International, 32 (10), 1989-1998. (doi:10.1007/s00198-021-05922-6).

Record type: Article

Abstract

Summary: we describe variation across geographical regions of England in operations undertaken following presentation of hip fracture and in 30-day mortality. Some significant geographic variation in 30-day mortality was observed particularly for patients with trochanteric hip fractures and warrants further investigation of other aspects of post-hip fracture care

Introduction: mortality after hip fracture has improved considerably in the UK over recent decades. Our aim here was to describe geographical variation in type of operation performed and 30-day mortality amongst patients in England with hip fracture.

Methods: the National Hip Fracture Database was used to carry out a prospective cohort study of nearly all over-60 year olds with hip fracture in England. These data were linked to Hospital Episode Statistics (HES), allowing us to explore regional variation in the operations performed for three fracture types (intracapsular, trochanteric and subtrochanteric), and use logistic regression models adjusted for demographic and clinical factors to describe associated 30-day mortality.

Results: NHFD recorded data for 64,211 patients who underwent surgery in England during 2017. Most had an intracapsular (59%) or trochanteric fracture (35%), and we found significant geographical variation across regions of England in use of total hip replacement (THR) (ranging from 10.1 to 17.4%) for intracapsular fracture and in intermedullary nailing (ranging from 14.9 to 27.0%) of trochanteric fracture. Some geographical variation in mortality amongst intracapsular fracture patients was found, with slightly higher mortality in the East of England (adjusted odds ratio [aOR]: 1.22, 95% CI: 1.02–1.46). Trochanteric fractures showed slightly more variation, with higher 30-day mortality (aOR: 1.40, 95%CI: 1.05–1.88) in the East of England and significantly lower mortality in the North East (aOR: 0.65, 95%CI: 0.46–0.93).

Conclusions: we have identified regional differences in operation type and 30-day mortality amongst hip fracture patients in England. The relationship between surgical approach and mortality has been explored, but the extent to which differential mortality reflects variation in approach to medical assessment, anaesthesia and other aspects of care warrants further investigation.

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More information

Accepted/In Press date: 10 March 2021
e-pub ahead of print date: 25 March 2021
Keywords: Epidemiology, Geographical variation, Hip fracture, Mortality, Surgery

Identifiers

Local EPrints ID: 448188
URI: http://eprints.soton.ac.uk/id/eprint/448188
ISSN: 0937-941X
PURE UUID: a2a30226-1311-48bd-8896-068ce1c79ff2
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 14 Apr 2021 16:41
Last modified: 30 Oct 2021 01:36

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Contributors

Author: Anjali Shah
Author: Samuel Hawley
Author: Dominic S Inman
Author: Cyrus Cooper ORCID iD
Author: Elizabeth Fagan
Author: Antony Johansen
Author: Andrew Judge

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