Patients with hip fractures are fragile and experiences loss of function, lower quality of life and the mortality is 10% at 30 days and 25% at one year. The mortality rate has not been lowered under 10% for many years and if we want to improve the conditions for hip fracture patients, a systematic approach is needed. A systematic approach includes data collected prior to and after hospital admission. Since the patient group is heterogenous their needs might therefore also be different. We intent therefore to divide the patient cohort into groups and to initiate targeted treatment bundles with different treatment strategies according targeted group and an individual assessment.
In hip fracture patients, the 30-day mortality rate is 10%, and at one year the mortality rate is 26-37%. This is a threefold increase in the one year mortality or an excess mortality of 8.4-36%. The mortality rates have not changed in the past 30 years so how can we lower the excess mortality?
Several factors contribute to increased mortality in hip fracture patients. Factors that preoperatively increases the risk of mortality include sex, age past 85 years, surgical delay, anemia high Charlson comorbidity index (CCI) score, cognitive impairment, place of residence, and degree of mobility. Prediction models found increased risk for death in admitted patients and especially the Nottingham Hip Fracture Score (NHFS) and Barthel score seems to be predictive for post-operative outcome. However, so far no prediction model has provided excellent discrimination and a solid prediction model is lacking. Lack of predictive properties in the current prediction models may be due to the fact that factors during and after surgery can increase the risk of mortality. E.g. low blood pressure during surgery can lead to kidney failure and increased mortality. Cementation increases the perioperative mortality due to bone cementation implant syndrome while at one month, cementation has the opposite effect. After surgery, admission to an orthogeriatric department lower the mortality possibly due to improved quality of care. Finally, mobilization within 24 hours lower mortality postoperatively.
Only 60% of those, who survive, recover the functional level they had before the accident, and 25% of the patients, who were independent before the fall, require admission to a home for the old. In fact, hip fracture survivors experience significantly worse mobility, independence in function, health, QoL and higher rates of institutionalisation than age matched controls. However, mobility can be improved, but there is insufficient evidence to establish the best strategies for enhancing mobility after hip fracture surgery. Impaired mobility along with reduced functional and social independence also influences health related QoL. Health related QoL can be measured by EQ5D, but there exists no patient reported outcome measures (PROM) for QoL in patients with hip fracture. In fact, we are not certain, what QoL means for hip fracture patients.
Data and biological material
Data concerning the admission, surgery, x-ray images, patient characteristics, questionnaires, and postoperative treatment is collected.