Gender Influences Patient Characteristics, Fracture Pattern, Achievement of Clinical Care Targets and Postoperative...

This study assesses whether patient gender is associated with differences in demographics and fracture characteristics, clinical care, mortality risk and length of acute hospital stay following a hip fracture.

A retrospective cohort study was undertaken of all patients aged ≥ 50 years admitted with a hip fracture from the emergency department (ED) at a single centre during a 42-month period. Patient demographics, perioperative variables and mortality were collected as part of the Scottish Hip Fracture Audit (SHFA).

3613 patients (mean age 80.9; 71% female) were included. The mean follow-up was 607 (range 240-1542) days. 1600 deaths were identified (44.3% mortality). Male patients were younger (p < 0.001), less likely to reside in a care home (p < 0.001), and more likely to sustain an extracapsular fracture (p = 0.048). Male patients spent longer in the ED (p = 0.030), were less likely to have the ED 'Big 6' completed (p = 0.017) and had a longer time to theatre (p = 0.001). Male gender was independently associated with an increased mortality risk (hazard ratio 1.56, 95% CI 1.39 to 1.74, p < 0.001, Cox regression) relative to females. Gender did not influence the length of acute hospital stay (mean difference 0.4 days, 95% CI 0.33 to 1.12, p = 0.290, regression analysis).

Despite adjusting for several observed differences, male gender is associated with a greater mortality risk. These differences should be explored further to improve clinical care and outcomes.