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      The impact of social deprivation on mortality following hip fracture in England and Wales: a record linkage study

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          Abstract

          Summary

          We used routine hospital data to investigate whether socially deprived patients had an increased risk of dying following hip fracture compared with affluent patients. We found that the most deprived patients had a significantly increased risk of dying at 30, 90 and 365 days compared with the most affluent patients.

          Introduction

          To identify whether social deprivation has any effect on mortality risk after emergency admission with hip fracture and to determine whether any increased mortality observed among deprived groups was associated with patient and hospital-related factors.

          Methods

          We used routine, linked hospital inpatient and mortality data for emergency admissions with a hip fracture in both England and Wales between 2004 and 2011. Mortality rates at 30, 90 and 365 days were reported. Logistic regression was used to identify any significant increases in mortality with higher levels of social deprivation and the influence of other risk factors on any increased mortality among the most deprived group.

          Results

          Mortality rates at 30, 90 and 365 days were 9.3, 17.4 and 29.0 % in England and 8.3, 16.1 and 27.9 % in Wales. Social deprivation was significantly associated with increased mortality in the most deprived quintile compared with the least deprived quintile at 30, 90 and 365 days in England (OR = 1.187, 1.185 and 1.154, respectively) and at 90 and 365 days in Wales (1.135 and 1.203). There was a little interaction between deprivation and other risk factors influencing 30- and 365-day mortality except for patient age, pre-fracture residence and hospital size.

          Conclusions

          We demonstrated a positive association between social deprivation and increased mortality at 30 days post-admission for hip fracture in both England and Wales that was still evident at 90 and 365 days. We found little influence of other factors on social inequalities in mortality risk at 30 and 365 days post-admission.

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          Is operative delay associated with increased mortality of hip fracture patients? Systematic review, meta-analysis, and meta-regression.

          Toshiya Shiga, Zen'ichiro Wajima, Yoko Ohe (2008)
          Mortality associated with hip fracture is high in elderly patients. Surgical repair within 24 hr after admission is recommended by The Royal College of Physicians' guidelines; however, the effect of operative delay on mortality remains controversial. The objective of this study was to determine whether operative delay increases mortality in elderly patients with hip fracture. Published English-language reports examining the effect of surgical delay on mortality in patients who underwent hip surgery were identified from electronic databases. The primary outcome was defined as all-cause mortality at 30 days and at one year. Effect sizes with corresponding 95% confidence intervals were calculated by using a DerSimonian-Laird randomeffects model. Sixteen prospective or retrospective observational studies (257,367 patients) on surgical timing and mortality in hip fracture patients were selected. When a cut-off of 48 hr from the time of admission was used to define operative delay, the odds ratio for 30-day mortality was 1.41 (95% CI = 1.29-1.54, P < 0.001), and that for one-year mortality was 1.32 (95% CI = 1.21-1.43, P < 0.001). In hip fracture patients, operative delay beyond 48 hr after admission may increase the odds of 30-day all-cause mortality by 41% and of one-year all-cause mortality by 32%. Potential residual confounding factors in observational studies may limit definitive conclusions. Although routine surgery within 48 hr after admission is hard to achieve in most facilities, anesthesiologists must be aware that an undue delay may be harmful to hip fracture patients, especially those at relatively low risk or those who are young.
          Article 0 comments Cited 150 times – based on 0 reviews     Review now
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            Early mortality after hip fracture: is delay before surgery important?

            Ronald K. Taylor, Allisyn Moran, Russell T Wenn … (2005)
            Hip fracture is associated with high mortality among the elderly. Most patients require surgery, but the timing of the operation remains controversial. Surgery within twenty-four hours after admission has been recommended, but evidence supporting this approach is lacking. The objective of this study was to determine whether a delay in surgery for hip fractures affects postoperative mortality among elderly patients. We conducted a prospective, observational study of 2660 patients who underwent surgical treatment of a hip fracture at one university hospital. We measured mortality rates following the surgery in relation to the delay in the surgery and the acute medical comorbidities on admission. The mortality following the hip fracture surgery was 9% (246 of 2660) at thirty days, 19% at ninety days, and 30% at twelve months. Of the patients who had been declared fit for surgery, those operated on without delay had a thirty-day mortality of 8.7% and those for whom the surgery had been delayed between one and four days had a thirty-day mortality of 7.3%. This difference was not significant (p = 0.51). The thirty-day mortality for patients for whom the surgery had been delayed for more than four days was 10.7%, and this small group had significantly increased mortality at ninety days (hazard ratio = 2.25; p = 0.001) and one year (hazard ratio = 2.4; p = 0.001). Patients who had been admitted with an acute medical comorbidity that required treatment prior to the surgery had a thirty-day mortality of 17%, which was nearly 2.5 times greater than that for patients who had been initially considered fit for surgery (hazard ratio = 2.3, 95% confidence interval = 1.6 to 3.3; p < 0.001). The thirty-day mortality following surgery for a hip fracture was 9%. Patients with medical comorbidities that delayed surgery had 2.5 times the risk of death within thirty days after the surgery compared with patients without comorbidities that delayed surgery. Mortality was not increased when the surgery was delayed up to four days for patients who were otherwise fit for hip fracture surgery. However, a delay of more than four days significantly increased mortality.
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              Mortality associated with delay in operation after hip fracture: observational study.

              Paul Aylin, Alex Bottle (2006)
              To estimate the number of deaths and readmissions associated with delay in operation after femoral fracture. Analysis of inpatient hospital episode statistics. NHS hospital trusts in England with at least 100 admissions for fractured neck of femur during the study period. Patients People aged > or = 65 admitted from home with fractured neck of femur and discharged between April 2001 and March 2004. In hospital mortality and emergency readmission within 28 days. There were 129,522 admissions for fractured neck of femur in 151 trusts with 18,508 deaths in hospital (14.3%). Delay in operation was associated with an increased risk of death in hospital, which was reduced but persisted after adjustment for comorbidity. For all deaths in hospital, the odds ratio for more than one day's delay relative to one day or less was 1.27 (95% confidence interval 1.23 to 1.32) after adjustment for comorbidity. The proportion with more than two days' delay ranged from 1.1% to 62.4% between trusts. If death rates in patients with at most one day's delay had been repeated throughout all 151 trusts in this study, there would have been an average of 581 (478 to 683) fewer total deaths per year (9.4% of the total). There was little evidence of an association between delay and emergency readmission. Delay in operation is associated with an increased risk of death but not readmission after a fractured neck of femur, even with adjustment for comorbidity, and there is wide variation between trusts.
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                Author and article information

                Contributors
                K. Thorne: +44 (0)1792 606372 , k.thorne@swansea.ac.uk
                Journal
                Journal ID (nlm-ta): Osteoporos Int
                Journal ID (iso-abbrev): Osteoporos Int
                Title: Osteoporosis International
                Publisher: Springer London (London )
                ISSN (Print): 0937-941X
                ISSN (Electronic): 1433-2965
                Publication date (Electronic): 20 April 2016
                Publication date PMC-release: 20 April 2016
                Publication date (Print): 2016
                Volume: 27
                Pages: 2727-2737
                Affiliations
                [1 ]Swansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP UK
                [2 ]Trauma Unit, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW UK
                Article
                Publisher ID: 3608
                DOI: 10.1007/s00198-016-3608-5
                PMC ID: 4981619
                PubMed ID: 27098537
                SO-VID: 853f56ae-594b-4257-ae52-306e728dbf29
                Copyright © © The Author(s) 2016
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 30 September 2015
                Date accepted : 1 March 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: Grant No: 093564/Z/10/Z
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © International Osteoporosis Foundation and National Osteoporosis Foundation 2016

                ScienceOpen disciplines: Orthopedics
                Keywords: hip fracture,mortality,risk factors,social deprivation
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: hip fracture, mortality, risk factors, social deprivation

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