22nd February 2019, Volume 132 Number 1490

Reuben J Kirk, Carlene MM Lawes, William Farrington, Peter Misur, Matthew L Walker, Michal Kluger, Min Yee Seow, Penny Andrew

Fractured neck of femur (NOF) is the most common cause for orthopaedic admission in older adults, and is associated with significant morbidity and mortality.1 The incidence of NOF fracture in…

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Summary

Our study investigated patient death rates following surgery for hip fracture at Waitemata DHB between 2009 and 2016. We found that 23.8% of patients died within one year of surgery; however death rates have gradually reduced in recent years. We also found that decreased time from hospital presentation to surgery was linked to improved survival in patients with hip fracture.

Abstract

Aim

Mortality rates of up to 38% at one year have been reported following surgery for neck of femur fractures. The aim of this review is to evaluate the post-operative mortality rates and trends over time for patients with fractured neck of femur at Waitemata District Health Board.

Method

A retrospective cohort study of all patients who received surgery following a neck of femur fracture at Waitemata District Health Board between 2009 and 2016. Inpatient data was retrieved from electronic hospital records and mortality rates from the Ministry of Health, New Zealand. Analyses included crude mortality rates and trends over time, and time-to-theatre from presentation with neck of femur fracture.

Results

A total of 2,822 patients were included in the study; mean age 81.9 years, 70.4% female and 29.6% male. Overall post-operative crude rates for inpatient, 30-day and one-year mortality were 3.7%, 7.2% and 23.8% respectively. Adjusted analyses showed a statistically significant decrease in mortality rates between 2009 and 2016 at inpatient (p=0.001), 30 days (p=<0.001) and one-year (p=<0.001) time periods. There was also a significant association between time-to-theatre and mortality at inpatient (p=0.002), 30 days (p=0.0001), and one-year (p=0.0002) time periods.

Conclusion

Mortality rates following surgery for fractured NOF have significantly improved over recent years at Waitemata District Health Board. Reduced time-to-theatre is associated with decreased inpatient, 30-day and one-year mortality.

Author Information

Reuben J Kirk, House Surgeon, Department of Orthopaedics, Waitemata District Health Board, Auckland; Carlene MM Lawes, Public Health Physician, Institute for Innovation and Improvement, Waitemata District Health Board, Auckland;
William Farrington, Orthopaedic Surgeon, Department of Orthopaedics, Waitemata District Health Board, Auckland; Peter Misur, Orthopaedic Surgeon, Department of Orthopaedics, Waitemata District Health Board, Auckland; Matthew L Walker, Clinical Director of Orthopaedics, Waitemata District Health Board, Auckland;
Michal Kluger, Anaesthetist, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland; Min Yee Seow, Orthogeriatrician, Department of Orthopaedics, Waitemata District Health Board, Auckland; 
Penny Andrew, Director of the Institute of Innovation and Improvement, Waitemata District Health Board, Auckland.

Acknowledgements

We acknowledge and thank Delwyn Armstrong, Head of Analytics, and Monique Greene, Information Analyst, Waitemata DHB for data extraction; and Varsha Parag, Biostatistician, National Institute of Health Innovation, University of Auckland for statistical analysis.

Correspondence

Dr Reuben Kirk, Department of Orthopaedics, Waitemata District Health Board, Private Bag 93-503, Takapuna, Auckland 0740.

Correspondence Email

reuben.kirk1@gmail.com

Competing Interests

Dr Misur reports personal fees from Stryker Corporation outside the submitted work.

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