Elsevier

Injury

Volume 39, Issue 10, October 2008, Pages 1157-1163
Injury

Mortality following hip fracture: Trends and geographical variations over the last 40 years

https://doi.org/10.1016/j.injury.2008.03.022Get rights and content

Summary

Hip fractures are an ever increasing cause of morbidity and mortality. Treatment of this condition requires an all-encompassing approach from prevention to post-operative care. It is important in such a situation to gather data on the incidence and trends of hip fractures to aid in the future treatment planning of this important condition. A review of all articles published on the outcome after hip fracture over a four decade period (1959–1998) was undertaken to determine any changes that had occurred in the demographics of patients and mortality over this time period. The mean age of patients sustaining hip fractures was found to be steadily increasing over the study period at a rate of 1 year of age for every 5-year time period. The mean age in the 1960s was 73 years to a mean of 79 years in the 1990s. No notable differences were seen in the proportion of male patients over the years but a definite downward trend was noticed with regard to intracapsular fractures. The mortality at 6 and 12 months after injury remained essentially unchanged over the four decades reviewed. Mortality after a hip fracture remains significant, being 11–23% at 6 months and 22–29% at 1 year from injury. Geographical variations exist in the mortality after hip fracture. More detailed international comparisons are required to determine if these differences in outcome are accounted for by the variations in the demographics of patients or due to diversities in treatment methods.

Introduction

A hip fracture or proximal femoral fracture is one of the commonest causes for admission to an acute orthopaedic ward. Treatment of hip fractures should by necessity begin with prevention. This approach underlines the need for meaningful data to help aid treatment planning. Over the last 40 years numerous journal publications have documented the outcome after hip fracture with regard to mortality and the demographics of these patients. With changes in the age structure, improving healthcare and increased life expectancy43 of the population it is to be expected that there will be a change in the demographics of these patients over the years. A few articles have previously documented this change over a limited time period for patients in a specific geographical region.26, 31, 39, 45 This study attempts to review all published scientific reports to determine if any changes in mortality and patient demographics have occurred over the years.

Section snippets

Materials and methods

A literature review was performed using MEDLINE with the search term of “mortality following hip fracture” to identify all related articles. The results of the search criteria revealed a large number of publications in line with the importance of hip fractures. It was decided to strictly include only articles related to patients aged over 60 years and those published over a chosen four decade period. Other inclusion criteria were reports of consecutive series of patients with a minimum

Results

Between the years of 1959 and 1998 we identified a total of 196 articles of which 142 articles were published in the English language. Only 36 published series on hip fracture satisfied our strict inclusion criteria. Table 1 presents these studies for each decade. The mean age of the patients was 73 years in the 1960s, 76 in the 1970s, 77 in the 1980s and 79 for the series after this date. Fig. 1 demonstrates these results graphically. There was no change in the proportion of males to females

Discussion

It is to be expected that as the proportion of the elderly in the population increases that the mean age of hip fracture patients will also increase. All previous studies that have studied the demographics of hip fracture patients have concentrated on their own geographic areas. Nilsson and Obrant31 from Sweden reported an increase in mean age of female patients from 73 years to 77 years over the years 1951 to 1975. For men the increase was 69 years to 72 years. A later study from Sweden45

Conflict of interest statement

The authors of this article confirm that there are no potential conflict of interest issues relating to the preparation and publication of this study.

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