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Archives of Osteoporosis

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01.12.2021 | Original Article

Nonoperative hip fracture management practices and patient survival compared to surgical care: an analysis of Estonian population-wide data

verfasst von: Pärt Prommik, Kaspar Tootsi, Toomas Saluse, Aare Märtson, Helgi Kolk

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2021

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Abstract

Summary

A notable proportion of hip fracture patients receive nonoperative management, but such practice is seldom analysed. Although highly variable reasons underpin hip fracture nonoperative management, none of these practices conclusively outweigh the superiority of operative management. Nonoperative management should be only considered when surgery is not an option.

Purpose

Reasons underpinning hip fracture (HF) nonoperative management (NOM) are seldom analysed. This study aims to identify the reasons behind NOM and assess the accuracy of these decisions using these patients’ survival compared with those treated with operative management (OM).

Methods

This is a retrospective cohort study based on population-wide administrative health data, including patients aged ≥ 50 with an index HF diagnosis between January 2009 and September 2017. NOM patients were subgrouped according to their expected prognoses, and their survival up to 36 months was compared with those treated surgically.

Results

From a total of 11,210 included patients, 6.8% (766) received NOM. Varying reasons lead to NOM, dividing them further into five distinct subgroups: (I) 46% NOM decision due to poor expected prognosis with OM; (II) 29% NOM decision due to poor expected prognosis for mixed reasons; (III) 15% NOM decision due to good expected prognosis with NOM; (IV) 8.0% NOM decision due to patient’s refusal of OM; and (V) 1.3% NOM decision due to occult HF. Only poor prognosis and patients who refused OM (I, II, IV) had worse survival than OM patients. However, a relatively high proportion of the poor prognosis patients survived 1 year (29%).

Conclusion

Although there was high variability in reasons underpinning HF NOM, none of these practices conclusively outweigh OM’s superiority. NOM should be considered with utmost care and only for patients for whom OM is out of the question — well-defined medical unfitness or carefully considered refusal by understanding the increased mortality risk.

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Titel: Nonoperative hip fracture management practices and patient survival compared to surgical care: an analysis of Estonian population-wide data
verfasst von: Pärt Prommik
Kaspar Tootsi
Toomas Saluse
Aare Märtson
Helgi Kolk
Publikationsdatum: 01.12.2021
Verlag: Springer London
Erschienen in: Archives of Osteoporosis / Ausgabe 1/2021
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-021-00973-y

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Nonoperative hip fracture management practices and patient survival compared to surgical care: an analysis of Estonian population-wide data

Abstract

Summary

Purpose

Methods

Results

Conclusion

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