A comparison of acute versus inpatient hip fractures

The aim is to identify any difference in patient populations and outcomes for those admitted acutely versus those who fracture their hip as an inpatient. Retrospective data was collected from the Scottish MSK audit. 18 months were analysed (01/2017-06/2018) to identify patient demographics and outcomes. It discovered 10,140 patients: 92% (9320/10,140) admitted acutely: 81% (7535/9320) own homes, 19% (1755/9320) care homes, <1% (31/9320) from other non-NHS origins. Inpatients accounted for 8% (820/10,140): 70% (578/820) were on acute wards, 20% (167/820) rehab, 9% (76/820) NHS Continuing Care. No difference in ages: 80.1 years acutes vs 80.2 years inpatients, p=0.73. Gender was significant amongst inpatients: males 11% (317/3009) vs females 7% (504/7133), p<0.001. The inpatient hip fractures had longer inpatient stays than the acutely admitted hip fractures (40 vs 17 days, p<0.001) and spent a longer time in rehabilitation (32 vs 25 days, p<0.001). They were less likely to return to their home/carehome in 30 days (23% vs 60%, p<0.001), or, at 60 days post-admission (41% vs 74%, p<0.001). Mortality rate was higher at 30 days (13% vs 6%, p<0.001) and at 60 days post-admission (21% vs 10%, p<0.001). There was no difference in readmission rates within 14 days. Inpatient hip fractures constitute a much smaller proportion compared with acute admissions, yet they've significantly worse outcomes. This may be because the acute fractures have been admitted following the recommended standards of care. Meanwhile, inpatients have already been admitted medically unwell and may have more co-morbidities.