In-hospital mortality following hip fracture care in southern Ontario.

BACKGROUND

The incidence of hip fractures is increasing within the aging population. We investigated the overall rate of in-hospital mortality following hip fracture and how this mortality rate compares across academic and community hospitals.

METHODS

We reviewed prospectively collected data from 17 hospitals in southern Ontario as part of a project to evaluate a new streamlined clinical care pathway developed for acute care of elderly patients with hip fractures. We collected demographic data, prefracture living status, acute care mortality and time to surgery, and we compared these data between community and academic hospitals.

RESULTS

Between March 2007 and February 2008, 2178 consecutive patients were admitted with a hip fracture to 13 community and 4 academic hospitals. The mean age was 79 years and 72% were women. The overall in-hospital mortality rate was 5.0%, with no difference between patients treated in academic versus community hospitals (p = 0.56). We found a greater rate of acute care in-hospital mortality for patients admitted from dependent-living facilities compared with those who were living independently (risk ratio 0.63, 95% confidence interval 0.42-0.96).

CONCLUSION

Acute care in-hospital mortality following hip fractures remains high and is consistent across academic and community hospitals. With the rising incidence of hip fractures, we need to improve the models of care for these patients to reduce mortality and to maximize functional outcomes while maintaining efficient use of limited health care resources.