Trends in neck of femur fracture incidence in EU15+ Countries from 1990-2017

Sugand, Kapil; Ali, Ramla; Goodall, Richard; Salciccioli, Justin D.; Marshall, Dominic C; Schuster-Bruce, James; Abdul-Jabar, Hani B.; Shalhoub, Joseph

doi:10.1016/j.injury.2022.11.038

Cited by 7 publications

(6 citation statements)

References 31 publications

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“…Our study also identified large increases in male hip fracture incidence, which is consistent with studies from other countries. [2][3][4] This is important; although males represent a significantly smaller proportion of overall hip fracture burden compared to females, their outcomes are worse with higher mortality rates, lower rates of return to domicile, and lower likelihood of post-fracture mobility independence. 15 One proposed explanation for the difference in identified incidence is a poorer focus on osteoporosis management in males following fracture, resulting in a sex treatment gap.…”

Section: Discussionmentioning

confidence: 99%

“…The hip is the third most common anatomical region in which fractures occur, 1 and presents a substantial challenge to health and social care services globally. 2 It is a common and potentially devastating injury for the individual concerned, generally occurring in vulnerable elderly patients with multiple comorbidities, requiring hospital admission for operative intervention. Despite improvements in management, hip fracture can result in substantial morbidity, with many patients failing to return to their pre-fracture functional status, requiring ongoing social care.…”

Section: Introductionmentioning

confidence: 99%

“…6 Although recent evidence has demonstrated that a reduction in the hip fracture incidence may be occurring in certain populations, the overall number of hip fractures across developed nations is anticipated to rise markedly due to an ageing population. 2,3 Therefore, the prediction of future trends in hip fracture is essential to inform the planning of financial and logistical resources to meet prospective demand and ensure standards of care are maintained. An understanding of sex-and age-specific hip fracture incidence can also enable targeted population-level prevention measures.…”

Section: Introductionmentioning

confidence: 99%

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The impact of an ageing population on future increases in hip fracture burden

Harris,

Clement,

MacLullich

et al. 2024

Bone Joint J

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AimsCurrent levels of hip fracture morbidity contribute greatly to the overall burden on health and social care services. Given the anticipated ageing of the population over the coming decade, there is potential for this burden to increase further, although the exact scale of impact has not been identified in contemporary literature. We therefore set out to predict the future incidence of hip fracture and help inform appropriate service provision to maintain an adequate standard of care.MethodsHistorical data from the Scottish Hip Fracture Audit (2017 to 2021) were used to identify monthly incidence rates. Established time series forecasting techniques (Exponential Smoothing and Autoregressive Integrated Moving Average) were then used to predict the annual number of hip fractures from 2022 to 2029, including adjustment for predicted changes in national population demographics. Predicted differences in service-level outcomes (length of stay and discharge destination) were analyzed, including the associated financial cost of any changes.ResultsBetween 2017 and 2021, the number of annual hip fractures increased from 6,675 to 7,797 (15%), with a rise in incidence from 313 to 350 per 100,000 (11%) for the at-risk population. By 2029, a combined average projection forecast the annual number of hip fractures at 10,311, with an incidence rate of 463 per 100,000, representing a 32% increase from 2021. Based upon these projections, assuming discharge rates remain constant, the total overall length of hospital stay following hip fracture in Scotland will increase by 60,699 days per annum, incurring an additional cost of at least £25 million per year. Approximately five more acute hip fracture beds may be required per hospital to accommodate this increased activity.ConclusionProjection modelling demonstrates that hip fracture burden and incidence will increase substantially by 2029, driven by an ageing population, with substantial implications for health and social care services.Cite this article: Bone Joint J 2024;106-B(1):62–68.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of an ageing population on future increases in hip fracture burden

Harris,

Clement,

MacLullich

et al. 2024

Bone Joint J

View full text Add to dashboard Cite

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“…Due to the consequences of an ageing population the number of hip fractures will reach an incidence of 4.5 million a year by 2050, despite hip fracture prevention measures. 2,3 There are large societal and economic burdens for patients and healthcare systems in relation to patients who suffer an acute hip fracture. 2,4 Efforts to identify at-risk patients could help to reduce mortality rates.…”

Section: Introductionmentioning

confidence: 99%

“…Due to the consequences of an ageing population the number of hip fractures will reach an incidence of 4.5 million a year by 2050, despite hip fracture prevention measures. 2,3…”

Section: Introductionmentioning

confidence: 99%

Postoperative hypotension following acute hip fracture surgery is a predictor of 30-day mortality

Donald,

Eniola,

Deierl

2024

Bone Joint J

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AimsHip fractures are some of the most common fractures encountered in orthopaedic practice. We aimed to identify whether perioperative hypotension is a predictor of 30-day mortality, and to stratify patient groups that would benefit from closer monitoring and early intervention. While there is literature on intraoperative blood pressure, there are limited studies examining pre- and postoperative blood pressure.MethodsWe conducted a prospective observational cohort study over a one-year period from December 2021 to December 2022. Patient demographic details, biochemical results, and haemodynamic observations were taken from electronic medical records. Statistical analysis was conducted with the Cox proportional hazards model, and the effects of independent variables estimated with the Wald statistic. Kaplan-Meier survival curves were estimated with the log-rank test.ResultsA total of 528 patients were identified as suitable for inclusion. On multivariate analysis, postoperative hypotension of a systolic blood pressure (SBP) < 90 mmHg two to 24 hours after surgery showed an increased hazard ratio (HR) for 30-day mortality (HR 4.6 (95% confidence interval (CI) 2.3 to 8.9); p < 0.001) and was an independent risk factor accounting for sex (HR 2.7 (95% CI 1.4 to 5.2); p = 0.003), age (HR 1.1 (95% CI 1.0 to 1.1); p = 0.016), American Society of Anesthesiologists grade (HR 2.7 (95% CI 1.5 to 4.6); p < 0.001), time to theatre > 24 hours (HR 2.1 (95% CI 1.1 to 4.2); p = 0.025), and preoperative anaemia (HR 2.3 (95% CI 1.0 to 5.2); p = 0.043). A preoperative SBP of < 120 mmHg was close to achieving significance (HR 1.9 (95% CI 0.99 to 3.6); p = 0.052).ConclusionOur study is the first to demonstrate that postoperative hypotension within the first 24 hours is an independent risk factor for 30-day mortality after hip fracture surgery. Clinicians should recognize patients who have a SBP of < 90 mmHg in the early postoperative period, and be aware of the increased mortality risk in this specific cohort who may benefit from a closer level of monitoring and early intervention.Cite this article: Bone Joint J 2024;106-B(2):189–194.

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Early mobilisation after hip fracture surgery is associated with improved patient outcomes: A systematic review and meta‐analysis

Agarwal,

Feng,

Maclullich

et al. 2024

Musculoskeletal Care

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IntroductionThe aims of this systematic review and meta‐analysis were to determine if after hip fracture surgery (1) early mobilisation is associated with improved clinical outcomes, and if so (2) are benefits directly proportional to how soon after surgery the patient mobilises.MethodsA Preferred Reporting Items for Systematic Reviews and Meta‐Analyses systematic review was conducted using four databases to identify all studies that compared postoperative early mobilisation with delayed mobilisation, in patients after hip fracture surgery. The Critical Appraisal Skills Programme checklist was employed for critical appraisal and evaluation of all studies that met the inclusion criteria.ResultsA total of 13 studies, including 297,435 patients were identified, of which 235,275 patients were mobilised early and 62,160 were mobilised late. Six studies assessed 30‐day mortality, of which two also investigated 30‐day complication rates. Pooled meta‐analysis demonstrated that there were significantly lower 30‐day mortality rates (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.31–0.41, p < 0.001) and complication rates (OR 0.43, 95% CI 0.36–0.51, p < 0.001) in patients mobilising early after hip fracture surgery. Five studies investigated length of stay (LOS) and meta‐analysis revealed no difference between groups (mean difference −0.57 days, 95% CI −1.89–0.74, p = 0.39).ConclusionEarly mobilisation in hip fracture patients is associated with a reduction in 30‐day mortality and complication rates compared to delayed mobilisation, but no difference in LOS. These findings illustrate that early mobilisation is associated with superior post operative outcomes. However, a direct casual effect remains to be demonstrated, and further work on the factors underlying delayed mobilisation is required.

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Trends in neck of femur fracture incidence in EU15+ Countries from 1990-2017

Cited by 7 publications

References 31 publications

The impact of an ageing population on future increases in hip fracture burden

The impact of an ageing population on future increases in hip fracture burden

Postoperative hypotension following acute hip fracture surgery is a predictor of 30-day mortality

Early mobilisation after hip fracture surgery is associated with improved patient outcomes: A systematic review and meta‐analysis

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