Differences in hip fracture care in Europe: a systematic review of recent annual reports of hip fracture registries

Werner, Maic; Macke, Christian; Gogol, M.; Krettek, Christian; Liodakis, Emmanouil

doi:10.1007/s00068-021-01797-8

Cited by 27 publications

(28 citation statements)

References 55 publications

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“…The pooled estimate for one-year mortality (24.2%) was similar to rates estimated by a recent international systematic review [2] and those reported by the Danish national audit, which has the benefit of unambiguous registry linkage [24]. The pooled estimate for 30-day mortality (4.7%) was however low in comparison to robust sources in other similar European countries, which range from 5.5 to 9.5% [24]. It is unclear whether this represents a true difference or if it is an indication of under-estimation.…”

Section: Discussionsupporting

confidence: 83%

“…All-cause hospital re-admission may be easier to capture and for patients to self-report. It has been included in a core outcome set for orthogeriatric management of hip fractures and is collected as an outcome in several European hip fracture audits [11,24]. A small minority of Irish studies collected quality of life, and none used the EQ-5D measure that is recommended by the hip fracture core outcome set and integrated into several hip fracture audits internationally [8,10].…”

Section: Discussionmentioning

confidence: 99%

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Long-term outcome collection after hip fracture in Ireland: a systematic review of traditional and grey literature

et al. 2023

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This review aimed to describe the methods and results from recent Irish research about post-acute hip fracture outcomes. Meta-analyses estimate the 30-day and 1-year mortality rate at 5% and 24% respectively. There is a need for standardised recommendations about which data should be recorded to aid national and international comparisons. Purpose Over 3700 older adults experience hip fracture in Ireland annually. The Irish Hip Fracture Database national audit records acute hospital data but lacks longer-term outcomes. This systematic review aimed to summarise and appraise recent Irish studies that collected long-term hip fracture outcomes and to generate pooled estimates where appropriate. Methods Electronic databases and grey literature were searched in April 2022 for articles, abstracts, and theses published from 2005 to 2022. Eligible studies were appraised by two authors and outcome collection details summarised. Meta-analyses of studies with common outcomes were conducted where the sample was generalisable to the broad hip fracture population. Results In total, 84 studies were identified from 20 clinical sites. Outcomes commonly recorded were mortality (n = 48 studies; 57%), function (n = 24; 29%), residence (n = 20; 24%), bone-related outcomes (n = 20; 24%), and mobility (n = 17; 20%). One year post-fracture was the most frequent time point, and patient telephone contact was the most common collection method used. Most studies did not report follow-up rates. Two meta-analyses were performed. The pooled estimate for one-year mortality was 24.2% (95% CI = 19.1-29.8%, I 2 = 93.8%, n = 12 studies, n = 4220 patients), and for 30-day mortality was 4.7% (95% CI = 3.6-5.9%, I 2 = 31.3%, n = 7 studies, n = 2092 patients). Reports of non-mortality outcomes were deemed inappropriate for meta-analysis. Conclusion Hip fracture long-term outcomes collected in Irish research are broadly in line with international recommendations. Heterogeneity of measures and poor reporting of methods and findings limits collation of results. Recommendations for standard outcome definitions nationally are warranted. Further research should explore the feasibility of recording longterm outcomes during routine hip fracture care in Ireland to enhance national audit.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Long-term outcome collection after hip fracture in Ireland: a systematic review of traditional and grey literature

et al. 2023

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“…Currently, only 75% of Irish hip fracture patients are operated on within 48 h of admission [ 2 ]. This is in contrast to countries such as Germany and Sweden where 72% and 66% of patients respectively are operated on within 24 h of admission [ 18 ]. An Orthogeriatric model of care has also been shown to reduce time to surgery, improve the overall quality of care and enhance patient outcomes [ 19 ].…”

Section: Discussionmentioning

confidence: 95%

Cost of hospitalisation for hip fracture—findings from the Irish hip fracture database

Ferris

Brent²,

Sørensen³

2022

Osteoporos Int

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Summary The authors utilised the Irish Hip Fracture Database (IHFD) to quantify the impact of hip fracture on the health service in terms of incidence, bed days and financial costs. The absolute number of hip fracture cases recorded by the IHFD has increased, as has the associated costs of hospitalisation. Introduction Hip fracture places a considerable clinical and financial burden on the healthcare system, with acute hospitalisation accounting for a substantial proportion of the costs incurred. This paper aimed to quantify the cost of hospitalisation for hip fracture in Ireland in terms of bed days and direct hospital costs. Methods The authors analysed 23,494 cases in the Irish Hip Fracture Database (IHFD) from 2014 to 2020. Case numbers and length of stay were analysed annually. Hospital costs for hip fracture were described using the 2020 Activity-Based Funding Price List, which outlines the fees paid to public hospitals for inpatient activity. Results For the time period 2014–2020, the total cost of hospitalisation for hip fracture was approximately €296 million, equating to approximately €11,700 per episode of care. The annual cost of hospitalisation increased from approximately €34 million in 2014 to €44 million in 2020. In 2020, the mean length of stay for hip fracture was 17 days accounting for > 62,600 acute hospital bed days. Conclusion The absolute number of hip fracture cases recorded by the IHFD has increased, as has the cost of hospitalisation. Given the current capacity issues and economic constraints, there is a growing need to prioritise time spent in the most expensive acute hospital setting to the immediate perioperative period and maximise the use of community services and early supportive discharge for the rehabilitation phase. Supplementary Information The online version contains supplementary material available at 10.1007/s00198-021-06294-7.

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“…A recent review of European national hip fracture audits concluded that hip fracture registries were a good tool with which to compare hospitals within one country, 22 but that they need to make the data they collect and present more uniform if international comparisons are to become feasible.…”

Section: Introductionmentioning

confidence: 99%

Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons

Johansen

Ojeda-Thies

Poacher

et al. 2022

The Bone & Joint Journal

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Aims The aim of this study was to explore current use of the Global Fragility Fracture Network (FFN) Minimum Common Dataset (MCD) within established national hip fracture registries, and to propose a revised MCD to enable international benchmarking for hip fracture care. Methods We compared all ten established national hip fracture registries: England, Wales, and Northern Ireland; Scotland; Australia and New Zealand; Republic of Ireland; Germany; the Netherlands; Sweden; Norway; Denmark; and Spain. We tabulated all questions included in each registry, and cross-referenced them against the 32 questions of the MCD dataset. Having identified those questions consistently used in the majority of national audits, and which additional fields were used less commonly, we then used consensus methods to establish a revised MCD. Results A total of 215 unique questions were used across the ten registries. Only 72 (34%) were used in more than one national audit, and only 32 (15%) by more than half of audits. Only one registry used all 32 questions from the 2014 MCD, and five questions were only collected by a single registry. Only 21 of the 32 questions in the MCD were used in the majority of national audits. Only three fields (anaesthetic grade, operation, and date/time of surgery) were used by all ten established audits. We presented these findings at the Asia-Pacific FFN meeting, and used an online questionnaire to capture feedback from expert clinicians from different countries. A draft revision of the MCD was then presented to all 95 nations represented at the Global FFN conference in September 2021, with online feedback again used to finalize the revised MCD. Conclusion The revised MCD will help aspirant nations establish new registry programmes, facilitate the integration of novel analytic techniques and greater multinational collaboration, and serve as an internationally-accepted standard for monitoring and improving hip fracture services. Cite this article: Bone Joint J 2022;104-B(6):721–728.

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Differences in hip fracture care in Europe: a systematic review of recent annual reports of hip fracture registries

Cited by 27 publications

References 55 publications

Long-term outcome collection after hip fracture in Ireland: a systematic review of traditional and grey literature

Long-term outcome collection after hip fracture in Ireland: a systematic review of traditional and grey literature

Cost of hospitalisation for hip fracture—findings from the Irish hip fracture database

Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons

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