26 Predictors of In-Hospital Mortality Post Hip Fracture: What Really Matters?. (16th September 2019)

• Record Type: Journal Article
• Authors: Ferris, Helena; Brent, Louise; Martin, Jennifer; Crowley, Philip; Coughlan, Tara
• Is Part Of: Age and ageing. Volume 48(2019)Supplement 3
• Page Start: iii17
• Page End: iii65
• Publication Date: 2019-09-16
• Subjects: Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afz103.16
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Background: The Irish Hip Fracture Database is a national clinical audit developed to improve fracture care and outcomes. Lack of integration with other databases, such as a National Death Register makes determination of longer term outcomes challenging. In hospital mortality is one quality indicator that can be very accurately measured. We sought to determine in-hospital mortality in the Irish Hip Fracture Cohort between 2013 and 2017 and to determine which factors most influenced this outcome with particular reference to the IHFD quality standards. Methods: A secondary analysis of the 15, 603 patients in the IHFD between 2013 and 2017 was conducted. Descriptive and analytical statistics were produced. Results: In-hospital mortality was 4.5% for the 5 years. Univariate logistic regression revealed 11 statistically significant predictors of in-hospital mortality of which only 4 (age, gender, pre-fracture mobility, mobilised day of/after surgery) remained significant after multivariate analysis. The most striking finding was that those patients not mobilised on the day of/after surgery were 46% more likely to die in hospital (OR 1.46, p<0.000, 95% CI 1.25-1.70). Conclusion: Measuring care is challenging and often one standard cannot reflect all aspects. The ability to be mobilised on the day of or day after surgery is a good composite measure of both patient and organisational factors in hip fracture care: timely surgery, adequate pain relief, prevention of delirium, admission to a ward with philosophy, skills and resources to encourage early mobility. While early mobility has always been encouraged this data suggests its adoption as a formal standard to which all units must comply.