Hip fractures: mortality, morbidity and surgical treatment

Fracture of the neck of the femur (or hip fracture) is an important cause of mortality and morbidity among the elderly, and contributes significantly to health care costs. This paper examines recent Canadian trends in mortality and hospital morbidity attributable to this condition. Age-standardized rates for deaths, hospital admissions and hospital days at ages 55 and over are presented, and average annual percentage changes are estimated for each of these statistics using logarithmic regression. Changing trends in surgical procedures used to treat femoral fractures are also examined and linked with mean lengths of hospital stays. Between 1972 and 1990, deaths due to femoral fractures declined an average 2.3% annually for women and 1.2% for men. Hospital admissions dropped 0.1% for women and remained stable for men, while hospital days fell by 2.9% and 1.9% respectively. Beginning in 1977 there was a marked reduction in the proportion of admissions due to femoral fractures for which no surgical intervention was recorded and a corresponding increase in the proportion of fractures treated surgically by open reduction. Changes over the past two decades in the surgical treatment of patients with fracture of the neck of the femur may have reduced the hospital care burden. It is not possible from the available data to determine whether changes in treatment have also contributed to the observed reduction in mortality due to hip fracture. Neither can this downward trend be attributed to a fall in the condition's incidence, given observed hospital admission rates. Programs to prevent osteoporosis, falls, and injuries from falls are needed to complement improvements in surgical procedures.