Hip fracture recovery ‘varies between hospitals’ – study

Patients with hip fractures face a postcode lottery of care depending on which hospital they are treated at, a new study suggests.

The proportion of patients who die within 30 days of fracturing their hip varies from 3.7% in some hospitals to 10% in others.

And the average length of hospital stay is just 12 days in some hospitals in England and Wales compared with 42 days in others.

Meanwhile the odds of being readmitted for more care vary from 3.7% to 30%, according to the new study, published in the journal Age and Ageing.

Each year, more than 70,000 older adults are admitted to hospital with a hip fracture in the UK.

Researchers, led by academics from the University of Bristol, decided to examine whether any factors within a hospital could determine outcomes for patients.

They examined all hip fracture cases among English and Welsh residents aged over 60 between April 2016 and March 2019.

The study, funded by the charity Versus Arthritis, assessed the length of time patients spent in hospital; their risk of death 30 days after being admitted to hospital and whether they needed to be readmitted to hospital.

During the time frame, some 178,757 patients were admitted, 6% of these were from Wales.

The average length of stay across all hospitals was 21 days.

Some 7.3% of patients died within 30 days and 15.3% were readmitted in the month after their fracture.

Researchers identified various factors which meant hospitals were more or less likely to have poorer outcomes.

These included:
– Hospitals with more orthopaedic staff saw their patients sent home sooner on average and these trusts were also less likely to see patients readmitted.
– Trusts which manage to get most patients out of bed the day after surgery also had patients with shorter spells in hospital.
– Hospitals which were able to provide surgery to most patients within 36 hours of admission saw a 10% reduced risk in patients dying within 30 days.
– Organisations which discussed patient experience also saw lower death rates.
– Hospitals with busier emergency departments saw a higher rate of patients being readmitted.

The authors wrote: “Hip fractures are a devastating injury, for which health care should be reliable and equitable, across the country.

“We have identified multiple, potentially modifiable, organisational-level factors associated with important clinical outcomes.”

Celia Gregson, professor in clinical epidemiology in the Musculoskeletal Research Unit at the University of Bristol and chief investigator of the study, said: “Patients should be able to expect to receive the same, high-quality care if they break their hip, irrespective of where they live or which hospital they attend.

“The results of our study have shown multiple, important points in the pathway of patient care which hospitals can focus on to streamline and improve the quality of their hip fracture services and patient outcomes.”

Deborah Alsina, chief executive at Versus Arthritis said: “This research highlights the worrying state of care for older people who break their hip.

“The findings show that older people have a high chance of dying in the weeks after breaking a hip, and that whether or not they survive varies enormously between NHS hospitals in England and Wales.

“Hip fractures mainly affect older people, many of whom live with multiple long-term conditions, and quality of care for people with hip fractures is a key indicator of whether we’re getting older people’s care right in general. This research suggests we are not.”

Professor Antony Johansen, clinical lead for the National Hip Fracture Database and an author on the study, added: “It’s vital that hospitals have enough staff – nurses and physiotherapists – so they can help patients get back on their feet quickly after a hip fracture, otherwise patients will lose their independence, and may even lose the will to recover.”

A spokesperson for the NHS in England said: “Hip fracture care in the UK has seen dramatic improvements in recent years, and an older person’s risk of dying has halved since 2007.

“While some variation is to be expected due to multiple and complex factors, we are continually monitoring data to bear down on unwarranted variation and inequalities, as well as supporting the early identification of those most at risk of falls and fracture so they can get help to avoid injury in the first place.”