Performing Hip Fracture Repair within 48 Hours from Admission May Decrease Mortality, the Israeli National Program for Quality Indicators Experience

Abstract

Background: Hip fractures are common among the elderly, due to lack of mobility, osteopenia and hypocalcaemia. Surgery for repairing a fracture in the femoral neck within 48 hours improves the clinical outcome. Objective: To measure the performance rate of hip fracture repair within 48 hours of admission, and the effect on mortality. Methods: The data were obtained from the Israeli National Program for Quality Indicators. The denominator included all the patients 65-year-old or older who was admitted and operated because of hip fracture, and the numerator included those who underwent surgical repair within 48 hours of admission. Results: There has been a significant improvement in the national level of compliance within 48 hour time spanfrom 71% in 2013 to 87% in 2018. The success rate for total hip replacement (THR) was 53%, 68%, 74%, 81%, 79% and 78%, for partial hip replacement (PHR) the success rate was 66%, 76%, 80%, 82%, 84%, and 86%, and for fixation it was 74%, 80%, 85%, 89%, 89% and 89%, for 2013, 2014, 2015, 2016, 2017 and 2018, respectively. The mortality rate within 30 days of the admission was 4% in patients who underwent hip fracture repair within 48 hours of the admission, and 6.1% in the patients who did not, respectively, with odds ratio (OR) of 0.645, 95% CI 0.5730.726, P < 0.0001. Conclusion: We could demonstrate a significant decrease in mortality of patients with hip fracture who underwent hip fracture repair within 48 hours of admission.