Epidemiology and outcome after hip fracture in the under 65s—Evidence from the Scottish Hip Fracture Audit

• Published in: Injury Vol. 39; no. 10; pp. 1175 - 1181
• Main Authors: Holt, G, Smith, R, Duncan, K, Hutchison, J.D, Gregori, A
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.10.2008; Elsevier
• Subjects: Age Distribution; Age Factors; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Audit; Biological and medical sciences; Diagnosis-Related Groups; Diseases of the osteoarticular system; Epidemiologic Methods; Epidemiology; Female; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Hip fracture; Hip Fractures - epidemiology; Hip Fractures - rehabilitation; Hip Fractures - surgery; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Orthopedics; Outcome; Prognosis; Recovery of Function; Residence Characteristics; Scotland - epidemiology; Traumas. Diseases due to physical agents; Treatment Outcome; Young; Scotland; Audit; Young; Hip fracture; Epidemiology; Outcome; Prognosis; Diseases of the osteoarticular system; Anesthesia; Fracture; Trauma; Hip
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2008.04.015

Summary Aim To report the epidemiology and outcomes after hip fractures in the patients under 65 years of age. Patients and methods We performed a prospective, multi-centre observational study using the Scottish Hip Fracture Audit Database. Case-mix, process and outcome data was collected by dedicated coordinators on site at the time of admission, at 120 days after the injury and on any re-operations within 12 months. The study cohort consisted of 1896 individuals aged 50–64 years. Patient variables and outcomes were compared to a control group of 15,461 individuals aged 75–89 years of age. The control group consisted of three modal 5-year age groups centred about a median age of 83 years, equal to the database value, excluding the effects of the extreme elderly who may act as confounders. Outcomes measures included 30- and 120-day mortality, length of hospital stay, place of residence and ambulatory status. A multivariate logistic regression model was used to compare outcome between groups while controlling for significant case-mix variables. Results Patients in the study cohort presented with lower ASA scores and were more likely to be independently mobile and live in their own home at the time of fracture ( p < 0.001). Pathological fractures were more common in younger patients and accounted for more than 1 in 20 fractures. Mortality at 30 and 120 days was significantly lower ( p < 0.0001) in the study cohort, however it was increased compared to age and gender adjusted mortality rates for the general population ( p < 0.001) Younger patients were more likely to recover independent mobility and living. Conclusion Patients aged 50–64 years have significantly better outcome measures after surgery for hip fracture in terms of survival and function. Such differences exist even after controlling for differences in patient case-mix variables.