OTA 2012 Posters

Scientific Poster #27 Hip/Femur OTA-2012

The National Hip Fracture Database in England, Wales, and Northern Ireland: Results From 50,000 Patients Treated in a 1-Year Period

Christopher G. Moran; R. Wakeman; C. Currie;
M. Partridge; Keith M. Willett, MD;
British Orthopaedic Association and British Geriatrics Society

Background/Purpose: The National Hip Fracture Database (NHFD) is a prospective audit of hip fracture care and secondary fracture prevention in England, Wales, and Northern Ireland (population 60 million). It is clinically led and web-based and collects a standard data set with central data storage and analysis. It was launched in 2007 and national participation has steadily increased. All 191 hospitals providing acute hip fracture care are now registered; the database holds records of 147,000 patients and collects data on 5000 new patients per month. This study reports the results of 53,443 patients aged >59 years admitted with a hip fracture between April 1, 2010 and March 31, 2011. This is a study of the entire population and, as such, provides Level I epidemiological evidence.

Methods: The total number of data fields documenting the 53,443 cases is 1,081,670, of which 998,435 (92.3%) were complete. Data is cross-referenced with the National Office of Statistics, which hold records of all deaths in the United Kingdom and this allows 100% follow-up for mortality statistics. The average age is 80 years and 21% of patients are aged >90 years. 73.9% are female. 74.1% were admitted from their own home and, before injury, 45.2% could walk without aid and 24.9 used a single stick. The fracture types were: undisplaced intracapsular (11.4%), displaced intracapsular (46.3%), intertrochanteric (33.8%), and subtrochanteric (5%). Displaced subcapital fractures were treated with arthroplasty and 68.2% of these were cemented. 83.6% of intertrochanteric fractures were treated with a sliding hip screw.

Results: A subgroup analysis was performed on a group of 28 hospitals with established NHFD participation, with data available from April 2008 to March 2011 and a high level of case reporting and data completeness. This subgroup included a total of 30,022 patients (9574 from April 2008 to March 2009; 10,075 from April 2009 to March 2010; 10,400 from April 2010 to Mar 2011) and was used to analyze trends in 6 care quality indicators. During this 3-year period, surgery within 36 hours of admission increased from 54% to 68% and surgery within 48 hours from 70% to 83%. Preoperative assessment by an orthogeriatrician increased from 28% to 55%, falls assessment from 52% to 85%, and osteoporosis assessment and treatment from 65% to 90%. These changes were mirrored by a 15% reduction in 30-day mortality from 9.4% to 8.0%. All of these changes were highly statistically and clinically significant.

Conclusions: We conclude that a web-based National Hip Fracture Database is an effective method of clinical audit. It allows the development of national benchmarks and performance indicators for individual units. Most importantly, it is a key catalyst in raising both the quality and cost-effectiveness of care for these frail, elderly patients.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.