The financial cost of hip fractures.

During the past decades there has been an adaptation to the increasing number of hip fracture patients in the hospital as well as an adaptation to the economic conditions in society. Different ways of reducing hospitalization time have been applied. At the beginning of the 1950's all rehabilitation activities for hip fracture patients in Sweden were performed in hospital. The patients were confined to bed for approximately 4 months, and the mean hospital stay was more than 5 months at the Lund University Hospital. Because of fear of healing complications the nonweight-bearing period was very long. It was reduced from 4 months to 2 months during the 1950's and from 2 months to one month at the end of the 1960's. The efforts to optimize and rationalize hip fracture treatment have continued (16). The mean hospitalization time decreased from 44 days to 16 days between 1966 and 1982, and discharge home from the hospital increased from 44% to 75% for patients coming from home. In 1993 the mean hospital stay at the Lund University Hospital was 14 days. This reduction was an effect of strategy changes in the treatment of hip fractures and of changes in surgical techniques and the introduction of a rehabilitation program at home, in collaboration with primary health care facilities (1, 6, 7). Rehabilitation using primary health care resources has proved to be an efficient model when compared with the previous organization of rehabilitation of hip fracture patients in Sweden.