Femoral fractures and orthopaedic surgery: a 4-year survey in Italy

Abstract

Femoral fractures are associated with a high rate of mortality, especially in the elderly, and high social and economic burdens. The impact of femoral fractures is of particular importance in countries like Italy with a progressively ageing population. Therefore, to quantify the real impact of femoral fractures, we studied national hospitalisation records. In a previous report we described the incidence and costs of hip fractures, while here we report our findings on the numbers and types of surgical interventions. We evaluated national records for operations of hip replacement and femoral fracture reduction in adults ≥45 years of age. Over 120 000 surgical hip interventions were performed in 2002; of these, more than 72 000 were directly attributable to femoral fractures. Between 1999 and 2002, the number of operations for femoral fractures increased by 7.1%, and in each year we observed a predominance of women and elderly, in line with the increased prevalence of osteoporosis in these populations. Together with our findings on an increased number of hospitalisations, these data indicate that in Italy the prevalence of hip fractures is increasing, and that women and elderly are the most affected. Primary prevention programmes to sensitise the population to the risks of osteoporotic fractures and to reduce the incidence, especially in high-risk subjects, are urgently needed.

Hip fractures in Italy: 2000–2005 extension study

“…In this perspective, total costs generated by hip fractures in the elderly Italian population are now estimated to exceed 1.3 billion Euros/ year. Our study confirms the findings of our previous analyses [5,17,18] and highlights the high social impact of hip fractures in elderly people. However, the large database of the Italian hospital records offers the opportunity of new studies concerning the differences across hip fracture types, such as between neck and trochanter fractures, which could be of particular interest especially for orthopedic surgeons.…”

“…Our findings seem to be consistent with IOF estimations concerning the overall incidence and costs of hip fractures in Italy [32] and provides further detailed information regarding the costs specifically generated by elderly people. Furthermore, these results are consistent with the national hospitalization database analyses of the surgical interventions following hip fractures we had already performed [18] and with data from other European [27,[33][34][35][36][37][38][39] and nonEuropean countries [40,41], where an increasing trend of hip fractures incidence and costs was shown for many industrialized countries. On the opposite, some previously published studies concerning Sweden [42], Switzerland [30,43], Australia [44], and Canada [45] have found a reversal in hip fractures incidence, mainly for women.…”

Incidence and costs of hip fractures compared to acute myocardial infarction in the Italian population: a 4-year survey

“…Our findings seem to be consistent with IOF estimates of the overall incidence and costs of hip fractures in Italy [3] and provides further detailed information regarding the costs specifically generated by elderly people. Furthermore, our findings are consistent with the national hospitalization database analysis concerning surgical aspects (the number of operations due to hip fractures) [27] and with data from other European countries [28][29][30][31] and from the United States [32][33][34], confirming the high social impact of hip fractures despite a worrisome lack in the perception of its severity [35]. Compared to our estimate of 1 billion Euros in Italy, the reported costs of osteoporotic fractures in other countries are (in US dollars) 2 billion for Canada and Australia [3,34,36], 31 billion in the United States [3,32] and 17 billion in EU countries [3].…”

Incidence and socioeconomic burden of hip fractures in Italy: extension study 2003-2005

“…Sulla scorta delle precedenti esperienze pubblicate in letteratura internazionale (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), questo studio si basa sull'analisi dei dati dell'archivio "Sche- Per quanto riguarda i costi attribuibili al DRG chirurgico 209, utilizzato anche per la codifica delle protesi d'anca dovute a coxartrosi femorale, abbiamo applicato dei fattori correttivi per calcolare la quota della spesa totale relativa al DRG 209 attribuibile agli interventi eseguiti per fratture femorali comprese nei codici di diagnosi principale ICD-9CM considerati (820.0, 820.1, 820.2, 820.3, 820.8, 820.9, 821.1). Una verifica specifica su di un campione significativo rappresentato dalla Regione Toscana e dall'ASL Lecce, ha calcolato che il 40% della spesa totale relativa al DRG 209 e l'80% della spesa calcolata per i DRG 210 e 211 erano da attribuirsi a diagnosi principali di frattura femorale.…”