26 Predictors of In-Hospital Mortality Post Hip Fracture: What Really Matters? (Age and Ageing)

AbstractBackgroundThe 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.MethodsA secondary analysis of the 15,603 patients in the IHFD between 2013 and 2017 was conducted. Descriptive and analytical statistics were produced.ResultsIn-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).ConclusionMeasuring 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.