Increased Mortality among Patients Sustaining Hip Fractures Requiring Surgery in a District General Hospital

Abstract

Fractures of the femoral neck are a common condition the incidence of which continues to rise. Associated mortality remains very high and knowledge of factors contributing to this high mortality is crucial in understanding outcome for both patient and surgeon. A retrospective review of 1254 patients operated on for fracture neck of femur was conducted to identify mortality at 30 days, 90 days and one year. Age, type of fracture, sex and waiting time for surgery were evaluated along with mortality for 47 patients who sustained their fracture while already inpatients with other concurrent illnesses. Those patients who sustained an inpatient fracture were found to have significantly higher mortality at 30 days, 90 days and one year. We concluded that these patients represent a very high-risk group that needs special consideration in management of their fracture and concurrent medical condition to reduce their high mortality.

Proximal femoral fracture outcomes in inpatients and community patients: A comparative study

“…A lack of guidance has been shown to have the resultant effect of delayed time to surgery compared to patients sustaining the same injury in the community 10 . This was highlighted in the patient cohort in this study; where average time to theatre from presentation was 27.8 hours for inpatients and 25.2 hours for those patients admitted from the community; results also reproduced in the study conducted by Hamilton et al (27.8 and 26.6 hours respectively) 11 .…”

“…When compared to the literature, mean age of the population in this study (79.6 years) was noted to be lower than that of aforementioned literature[ 11 , 13 ]. However, the percentage of our study population that acquired a proximal femoral fracture as an inpatient was 8.5%, significantly higher than the described literature (4% and 6% respectively).…”

“…These findings were consistent with the results of this study, which found that 54% of patients sustaining proximal femoral fractures as inpatients were located on medical wards, at the time of their injury and 35% were on rehabilitation wards. One must note that patients admitted to acute medical, geriatric and rehabilitation wards are often frail and of poor overall health 11,14 . These patients, as described above, are at increased risk of falls whilst an inpatient.…”

“…One must note that patients admitted to acute medical, geriatric and rehabilitation wards are often frail and of poor overall health[ 11 , 14 ]. These patients, as described above, are at increased risk of falls whilst an inpatient.…”

Increased Mortality Amongst Patients Sustaining Neck of Femur Fractures as In-Patients in a Trauma Centre

“…Existing research carried out by Hamilton et al shows an increased mortality for patients who suffered their NOF fracture as an in-patient. It also noted a longer mean waiting time for surgery and increased in-patient stay [ 4 , 5 ]. This same study highlighted that the reasons for admission of patients who suffered in-patient NOFs were recurrent falls/confusion, cardiac disease and stroke.…”