Background
Methods
Subjects and facilities
Collection of data
Outcomes and statistical analyses
Results
Subject characteristics
Femoral fracture patients | Forearm fracture patients | |||
---|---|---|---|---|
All hospitals | Acute-care hospitals | Rehabilitation hospitals | Acute-care hospitals | |
Number of patients
|
12,520
|
3914 (31.3%)
|
8606 (68.7%)
|
2031 (100%)
|
Sex
| F: 9580 (76.5%) | F: 2975 (76.0%) | F: 6605 (76.7%) | F: 1658 (81.6%) |
M: 2940 (23.5%) | M: 939 (24.0%) | M: 2001 (23.3%) | M: 373 (18.4%) | |
Age: mean (± SD)
| F: 79.1 (9.9) | Comparison acute-care versus rehabilitation facilities: | F: 69.4 (12.3) | |
M: 72.5 (12.9) | F: 81.3 (9.8) versus 78.1 (9.9) Δ = 3.2 years (p < 0.0001) | M: 59.4 (13.8) | ||
(p < 0.0001) | M: 73.8 (13.3) versus 71.9 (12.6) Δ = 1.9 years (p < 0.0002) | (p < 0.0001) | ||
BMI (kg/m
2
)
| < 25: 56.3% | Acute-care versus rehabilitation: < 25: 60.6% vs. 54.4% | < 25: 42.7% | |
25–29.9: 32.6% | 25–29.9: 30.8% vs. 33.4% | 25–29.9: 42.2% | ||
≥ 30: 11.1% | ≥ 30: 8.6% vs. 12.2% | ≥ 30: 15.2% | ||
(p < 0.0001) | ||||
ASA classification
| (I) 11.1% | Acute-care versus rehabilitation: (I): 5.3% vs. 13.6% | (I) 28.8% | |
(II) 46.7% | (II): 34.2% vs. 52.4% | (II) 51.4% | ||
(III) 38.7% | (III): 55.2% vs. 31.3% | (III) 19.1% | ||
(IV+V) 3.6% | (IV+V): 5.3% vs. 2.7% | (IV+V) 3.6% | ||
(p < 0.0001) | ||||
Presenting fracture (% of all patients)
| Proximal femur: 10,865 (86.8%) Distal femur: 138 (1.1%) Combination (usually with radius) or unclassified: 1,517 (12.1%) | Proximal femur: 3623 (92.6%) Distal femur: 27 (0.7%) Combination (usually with radius) or unclassified: 264 (6.7%) | Proximal femur: 7242 (84.2%) Distal femur: 111 (1.3%) Combination (usually with radius) or unclassified: 1253 (14.6%) | F: left arm 58.9%, right arm 39.6%, both arms 1.5% M: left arm 48.4%, right arm 50%, both arms 1.6% |
Previous fracture (% of all patients)
| 4010 (32.0%) | 1170 (29.9%) | 2840 (33.0%) | 569 (28.0%) |
Fracture location (% of all patients with a previous fracture, multiple locations possible)
| Radius: 11.2% | Radius: 10.4% | Radius: 11.6% | Radius: 12.6% |
Humerus: 4.5% | Humerus: 4.3% | Humerus: 4.7% | Humerus: 2.8% | |
Vertebra: 4.4% | Vertebra: 3.7% | Vertebra: 4.7% | Vertebra: 2.6% | |
Femur: 7.4% | Femur: 7.2% | Femur: 7.5% | Femur: 3.0% | |
Other: 12.4% | Other: 11.2% | Other: 12.9% | Other: 11.8% | |
Low bone density
| 33.7% | 25.9% of 792 patients | 37.0% of 1889 patients | 23.4% of 590 patients |
Reported comorbidities (% of all patients, multiple comorbidities possible)
| Hypertension: 61.2% | Hypertension: 64.6% | Hypertension: 59.6% | Hypertension: 48.9% |
Diabetes: 20.5% | Diabetes: 22.6% | Diabetes: 19.5% | Diabetes: 11.3% | |
CHD: 36.0% | CHD: 45.1% | CHD: 31.7% | CHD: 21.2% | |
MI: 7.0% | MI: 7.6% | MI: 6.7% | MI: 3.2% | |
PAD: 13.5% | PAD: 20.7% | PAD: 10.2% | PAD: 8.2% | |
Stroke: 11.8% | Stroke: 14.0% | Stroke: 10.9% | Stroke: 4.8 | |
Arthritis: 34.8% | Arthritis: 30.0% | Arthritis: 36.9% | Arthritis: 23.9% | |
Rheumatism: 5.0% | Rheumatism: 5.4% | Rheumatism: 4.8% | Rheumatism: 3.6% | |
COPD: 11.4% | COPD: 13.1% | COPD: 10.7% | COPD: 7.4% | |
Malignant tumour: 10.1% | Malignant tumour: 10.0% | Malignant tumour: 10.2% | Malignant tumour: 5.9% | |
Kidney dysfunction: 6.0% | Kidney dysfunction: 8.9% | Kidney dysfunction: 4.6% | Kidney dysfunction: 2.0% |
Mortality rates
Acute-care/femoral fracture | Rehabilitation/femoral fracture | Acute-care/forearm fracture | |
---|---|---|---|
All admission patients
|
12,520
|
2031
| |
Number of admission patients by type of hospital
|
3914 (31.3%) F: 2975 (76.0%)/M: 939 (24.0%)
|
8606 (68.7%) F: 6605 (76.7%)/M: 2001 (23.3%)
|
2031 (100%) F: 1658 (81.6%)/M: 373 (18.4%)
|
Deceased during hospital stay (mean age ± SD)
| 103 (2.6% of 3914) 85.3 years (± 8.2) | 16 (0.2% of 8606) 85.5 years (± 7.3) | 3 (0.15% of 2031) |
Sex breakdown of deceased pa-tients: N and mean age (± SD)
| F: 72 (2.4% of 2975) 86.7 years (± 6.6) M: 31 (3.3% of 939) 81.9 years (± 10.4) | F: 10 (0.15% of 6605) 85.8 years (± 7.3) M: 6 (0.3% of 2001) 85.1 years (± 7.9) | F: 3 (0.2% of 1658) 81.3 years (± 6.6) |
t-Test age difference
| p = 0.005 | p = 0.86 | |
All discharge patients
|
12,401
|
2028
| |
Number of discharged patients by type of hospital
|
3811 (30.7% of 12,401) F: 2903 (76.2%)/M: 908 (23.8%)
|
8590 (69.3% of 12,401) F: 6595 (76.8%)/M: 1995 (23.2%)
|
2028 F: 1655 (81.6%)/M: 373 (18.4%)
|
Deceased any time post discharge (mean age ± SD)
| 733 (19.2% of 3811) 83.9 years (± 8.7) | 730 (8.5% of 8590) 81.6 years (± 9.4) | 60 (3.0% of 2028) 80.4 years (± 9.9) |
Sex breakdown deceased pa-tients: N and mean age (± SD)
| F: 551 (19.0% of 2903) 85.0 years (± 8.0) M: 182 (20.0% of 908) 80.6 years (± 9.9) | F: 519 (7.9% of 6595) 83.0 years (± 8.6) M: 211 (10.6% of 1995) 78.1 years (± 10.3) | F: 54 (3.3% of 1655) 81.2 years (± 9.3) M: 6 (1.6% of 373) 73.7 years (± 13.1) |
t-Test age difference deceased patients
| p < 0.0001 | p < 0.0001 | p = 0.08 |
Chi-sq sex vs. hospital type deceased patients
| p = 0.08 |
Fracture location | Patients deceased in the first year N (percentage), or mean (± SD) | ||
---|---|---|---|
Acute-care
|
Rehabilitation
| ||
Pertrochanteric: 625 (13.2% of 4730) | 335 (20.6% of 1624) | 290 (9.3% of 3106) | Chi square acute-care: p = 0.0007 Chi square rehabilitation: p = 0.0003 |
Cervical: 554 (9.8% of 5662) | 281 (16.1% of 1744) | 273 (7.0% of 3918) | |
Women
|
Men
| ||
Pertrochanteric: 625
| 473 (13.1% of 3603) | 152 (13.5% of 1127) | Chi square women: p < 0.0001 Chi square men: P = 0.477 |
Cervical: 554
| 388 (9.0% of 4336) | 166 (12.5% of 1326) | |
Age Women
|
Age Men
| ||
Pertrochanteric: 625
| 85.1 (± 7.9) | 78.6 (± 11.2) | t-Test women: p = 0.0006 t-Test men: p = 0.45 |
Cervical: 554
| 83.2 (± 8.0) | 79.5 (± 9.4) | |
ASA Women
|
ASA Men
| ||
Pertrochanteric: 625
| 2.8 (± 0.6) | 2.8 (± 0.7) | t-Test women: p = 0.005 t-Test men: p = 0.98 |
Cervical: 554
| 2.7 (± 0.7) | 2.8 (± 0.7) | |
BMI Women
|
BMI Men
| ||
Pertrochanteric: 625
| 23.2 (± 4.5) | 24.1 (± 4.0) | t-Test women: p = 0.26 t-Test men: p = 0.84 |
Cervical: 554
| 23.6 (± 4.6) | 24.0 (± 3.8) |
Fracture site, operative treatment, and previous fractures
Certain or most probable fracture location: Total (% of 12,401) | Acute-care facilities 3,811 patients | Rehabilitation facilities 8,590 patients | ||
---|---|---|---|---|
Total (% of 3,811)
|
Women
|
Total (% of 8,590)
|
Women
| |
Cervical: 5662 (45.7%)
| 1744 (45.8%) | 1321 (75.7%) | 3918 (45.6%) | 3015 (77.0%) |
Pertrochanteric: 4730 (38.1%)
| 1624 (42.6%) | 1229 (75.7%) | 3106 (36.2%) | 2374 (76.4%) |
Subtrochanteric: 365 (2.9%)
| 160 (4.2%) | 119 (74.4%) | 205 (2.4%) | 155 (75.6%) |
Distal: 135 (1.1%)
| 24 (0.6%) | 19 (79%) | 111 (1.3%) | 85 (76.6%) |
Periprosthetic: 33 (0.3%)
| 12 (0.3%) | 8 (67%) | 21 (0.2%) | 16 (76%) |
Combination fracture: 676 (5.5%)
| 224 (5.9%) | 186 (83.0%) | 452 (5.3%) | 359 (79.4%) |
Unclassified fracture: 800 (6.5%)
| 23 (0.6%) | 21 (91%) | 777 (9.0%) | 591 (76.1%) |
Fracture location | ||||||
---|---|---|---|---|---|---|
Acute-care patients at discharge (n = 3811) | Cervical (n = 1744) | Pertrochanteric (n = 1624) | Subtrochanteric (n = 160) | Distal (n = 24) | Other, incl. peripros-thetic, or unclassified (n = 35) | Combination (n = 224) |
OP yes (%) | 1673 (96.3%) | 1612 (99.4%) | 156 (97.5%) | 23 (95.8%) | 31 (88.6%) | 217 (96.9%) |
OP no (%) | 65 (3.7%) | 10 (0.6%) | 4 (2.5%) | 1 (4.2%) | 4 (11.4%) | 7 (3.1%) |
Missing (n) | 6 | 2 | 0 | 0 | 0 | 0 |
Rehabilitation patients at discharge (n = 8590)
|
Cervical (n = 3918)
|
Pertrochanteric (n = 3106)
|
Subtrochanteric (n = 205)
|
Distal (n = 211)
|
Other, incl. peripros-thetic, or unclassified (n = 798)
|
Combination (n = 452)
|
OP yes (%) | 3355 (98.6%) | 2652 (99.7%) | 175 (100%) | 101 (98.1%) | 665 (97.2%) | 374 (90.8%) |
OP no (%) | 46 (1.4%) | 8 (0.3%) | 0 | 2 (1.9%) | 19 (2.8%) | 38 (9.2%) |
Missing (n) | 517 | 446 | 30 | 108 | 114 | 40 |
All femoral fracture patients at discharge
|
Cervical (n = 5662)
|
Pertrochanteric (n = 4730)
|
Subtrochanteric (n = 365)
|
Distal (n = 235)
|
Other, incl. peripros-thetic, or unclassified (n = 833)
|
Combination (n = 676)
|
Total number of OPs (acute and rehab)
| 5028 (97.8%) | 4264 (99.6%) | 331 (98.8%) | 124 (97.6%) | 696 (96.8%) | 591 (92.9%) |
Procedure (more than one response possible)
|
% each in reference to total number of known OPs
| |||||
Nailing | 237 (4.7%) | 2833 (66.4%) | 251 (75.9%) | 57 (46.0%) | 246 (35.3%) | 227 (38.4%) |
THP | 2046 (40.7%) | 105 (2.5%) | 17 (5.1%) | 11 (8.9%) | 191 (27.4%) | 105 (17.8%) |
Screw or screws | 943 (18.8%) | 1280 (30.0%) | 63 (19.0%) | 19 (15.3%) | 146 (21.0%) | 137 (23.2%) |
Intramedullary rod | 14 (0.3%) | 115 (2.7%) | 8 (2.4%) | 2 (1.6%) | 18 (2.6%) | 9 (1.5%) |
Monopolar femoral head prosthesis | 204 (4.1%) | 12 (0.3%) | 1 (0.3%) | 2 (1.6%) | 12 (1.7%) | 13 (2.2%) |
Bipolar femoral head prosthesis | 2011 (40.0%) | 72 (1.7%) | 8 (2.4%) | 2 (1.6%) | 150 (21.6%) | 111 (18.8%) |
Other (incl. ligament suture) | 82 (1.6%) | 241 (5.7%) | 15 (4.5%) | 9 (7.3%) | 33 (4.7%) | 63 (10.7%) |
K wire | 7 (0.1%) | 10 (0.2%) | 2 (0.6%) | 2 (1.6%) | 7 (1.0%) | 52 (8.8%) |
Plate | 112 (2.2%) | 496 (11.6%) | 53 (16.0%) | 46 (37.1%) | 71 (10.2%) | 70 (11.8%) |
Telephone interviews
Femur | Distal Forearm | |||
---|---|---|---|---|
Discharge without interview participation afterwards | Discharge with interview participation afterwards | Discharge without interview participation afterwards | Discharge with interview participation afterwards | |
Number of patients
| 8,145 | 4,256 | 1,054 | 974 |
Number of patients Acute-care and rehab hospitals
| Acute F: 2279/M: 651 | Acute F: 624/M: 257 | Acute F: 871/M: 183 | Acute F: 784/M: 190 |
Rehab. F: 4074/M: 1141 | Rehab. F: 2521/M: 854 | |||
Sex distribution (%) and Chi square
| F: 6353 (78.0%) | F: 3145 (73.9%) | F: 871 (82.6%) | F: 784 (80.5%) |
M: 1792 (22.0%) | M: 1111 (26.1%) | M: 183 (17.4%) | M: 190 (19.5%) | |
p < 0.0001 | p = 0.21 | |||
Age in years mean (± SD) t-Test
| F: 80.6 (± 9.4) | F: 75.7 (± 10.2) | F: 72.1 (± 12.7) | F: 66.4 (± 11.0) |
M: 73.8 (± 13.0) | M: 70.2 (± 12.4) | M: 59.7 (± 15.7) | M: 59.1 (± 11.8) | |
p < 0.0001 | p < 0.0001 | p < 0.0001 | p < 0.0001 | |
Δ Age [95% CI] interview – discharge
| F: Δ = -4.9 [-4.5 ; -5.3] | F: Δ = -5.7 [-4.6 ; -6.9] | ||
M: Δ = -3.6 [-2.6 ; -4.6] | M: Δ = -0.6 [-3.5 ; +2.2] | |||
ASA classification mean (± SD) t-Test
| F: 2.44 (± 0.69) | F: 2.15 (± 0.69) | F: 2.10 (± 0.68) | F: 1.80 (± 0.70) |
M: 2.44 (± 0.76) | M: 2.14 (± 0.79) | M: 1.78 (± 0.69) | M: 1.69 (± 0.72) | |
p = 0.89 | p = 0.71 | p < 0.0001 | p = 0.056 | |
Δ ASA [95% CI] interview – discharge
| F: Δ = -0.29 [-0.26 ; -0.32] | F: Δ = -0.30 [-0.24 ; -0.37] | ||
M: Δ = -0.30 [-0.24 ; -0.36] | M: Δ = -0.09 [-0.24 ; +0.05] |