Improved outcome after hip fracture surgery in Norway

Abstract

Background and purposeThe operative treatment of hip fractures in Norway has changed considerably during the last decade. We used data in the Norwegian Hip Fracture Register to investigate possible effects of these changes on reoperations and 1-year mortality.Patients and methods72,741 femoral neck (FFN) fractures and trochanteric fractures in patients 60 years or older were analyzed. The fractures were divided into 5 time periods (2005–2006, 2007–2008, 2009–2010, 2011–2012, 2013–2014). Cox regression models were used to calculate unadjusted and adjusted (age group, sex, and ASA class) relative risks (RRs) of reoperation and of 1-year mortality in the different time periods.ResultsFor undisplaced FFNs treatment with hemiarthroplasty increased from 2.1% to 9.7% during the study period. For displaced FFNs treatment with arthroplasty increased from 56% to 93%. The use of intramedullary nails increased from 9.1% to 26% for stable 2-fragment (AO/OTA A1) trochanteric fractures, from 15% to 33% for multifragment (AO/OTA A2) trochanteric fractures, and from 27% to 61% for intertrochanteric fractures (AO/OTA A3)/subtrochanteric fractures. Compared with the first time period the adjusted 1-year RR for reoperation was 0.43 (95% CI: 0.37–0.49) for displaced FFNs in the last time period. The adjusted 1-year mortality in the last time period was lower for all fractures (RR: 0.87 (0.83–0.91)), displaced FFNs (RR: 0.86 (0.80–0.93)), AO/OTA A1 trochanteric fractures (RR: 0.79 (0.71–0.88)), and AO/OTA A2 trochanteric fractures (RR: 0.87 (0.77–0.98)) when compared with the first study period.InterpretationHip fracture treatment in Norway has improved: The risk of reoperation and the 1-year mortality after displaced femoral neck fractures have decreased over a 10-year period. National registration is useful to monitor trends in treatment and outcomes after hip fractures.

“I struggle to count my blessings”: recovery after hip fracture from the patients’ perspective

“…In Norway, people sustaining a hip fracture have a mean age of 80 years and most often hip fractures occur in women [ 1 , 2 ], which correspond well with the participants in our study. During hospital stay some of the participants felt vulnerable and cut off from the world.…”

“…Hip fracture is one of the most common fractures in older people. The annual incidence rate of hip fractures in Norway is approximately 9000 patients [ 1 ], 71% of them are women [ 2 ]. Worldwide, the burden of hip fractures is a serious health problem - for the patients as pain and functional decline, for their families, and for the society in a health economic perspective [ 3 ].…”

<p>The Danish Multidisciplinary Hip Fracture Registry 13-Year Results from a Population-Based Cohort of Hip Fracture Patients</p>

“…Continuous monitoring of the quality of healthcare has been implemented in many European countries 14 including Finland (PERFormance, Effectiveness and Cost of Treatment episodes), 47 Sweden (Rikshöft), 48 the United Kingdom (UK) (the National Hip Fracture Database), 13,49 Scotland (the Scottish Hip Fracture Audit), 50 Italy (Regional Outcome Evaluation Program in the Lazio region 51 and Gruppo Italiano di Ortogeriatria), 52 Norway (The Norwegian Hip Fracture Registry), 53 Spain (National Hip Fracture Registry), 54 Ireland (Irish Hip Fracture database), 55 Nederlands (Dutch National Hip Fracture Audit), 56 Germany (Alterstrauma register), 57 and Denmark (DMHFR). However, the majority of these registries 47,50,51,[53][54][55] mainly monitor outcome performance measures, eg, mortality and readmissions at the hospital level, and lack continuous monitoring of process performance measures. Exceptions are the DMHFR, Rikshöft 48 and the National Hip Fracture Database in the UK, 13,49 which contain valuable information on process performance measures according to clinical guideline recommendations.…”

Kunnskap for politikk og praksis? En analyseav Stoltenbergutvalgets kunnskapssyn

“…I evidenshierarkiet kvalifiserer dette til topplassering på linje med RCTer. Nasjonalt hoftebruddregister er eksempel på et medisinsk kvalitetsregister som overvåker behandling av hoftebruddene for å bedre resultatene for pasientene (Gjertsen et al, 2017). Hoftebruddregisteret skal bidra til økt kunnskap om hvilke operasjonsmetoder og implantater som bør benyttes, og har stor betydning for hvordan kirurgisk praksis utvikles.…”