The burden of second hip fractures: provincial surgical hospitalizations over 15 years

The burden of second hip fractures: provincial surgical hospitalizations over 15 years

Can J Surg 2017;60(2):101-107 | PDF

Pierre Guy, MD, MBA; Boris Sobolev, PhD; Katie Jane Sheehan, PhD; Lisa Kuramoto, MSc; Kelly Ann Lefaivre, MD, MSc

Abstract

Background: Second hip fractures account for up to 15% of all hip fractures. We sought to determine if the proportion of hip fracture surgeries for second hip fracture changed over time in terms of patient and fracture characteristics.

Methods: We reviewed the records of patients older than 60 years hospitalized for hip fracture surgery between 1990 and 2005 in British Columbia. We studied the proportion of surgeries for second hip fracture among all hip fracture surgeries. Linear regression tested for trends across fiscal years for women and men.

Results: We obtained 46 341 patient records. Second hip fracture accounted for 8.3% of hip fracture surgeries. For women the proportion of second hip fracture surgeries increased linearly from 4% to 13% with each age decade (p = 0.001) and across fiscal years (p = 0.002). In men the proportion of second hip fracture surgeries was 5% for each age decade between the ages of 60 and 90 years across fiscal years, increasing to 8% for men older than 90 years across fiscal years (p = 0.20). These sex-specific trends were similar for both pertrochanteric and transcervical fracture types.

Conclusion: Second hip fracture surgeries account for an increasing proportion of hip fracture surgeries and may require more health care resources to minimize poorer reported outcomes. Future research should determine whether more health care resources are required to manage these patients and optimize their outcomes.

Résumé

Contexte : Les secondes fractures de la hanche représentent jusqu’à 15 % de la totalité des fractures de la hanche. Nous avons tenté de déterminer si la proportion de chirurgies de seconde fracture de la hanche avait évolué au fil du temps sur le plan des caractéristiques des patients et des fractures.

Méthodes : Nous avons examiné les dossiers des patients de 60 ans et plus qui avaient été hospitalisés pour une chirurgie de fracture de la hanche entre 1990 et 2005, en Colombie-Britannique. De ce total, nous avons ensuite déterminé le nombre de chirurgies de seconde fracture de la hanche. L’analyse de régression linéaire a déterminé les tendances au cours des années financières pour les femmes et les hommes.

Résultats : Nous avons obtenu 46 341 dossiers de patient. Les secondes fractures de la hanche représentaient 8,3 % de la totalité des chirurgies de fracture de la hanche. Chez les femmes, la proportion de seconde fracture de la hanche augmentait de façon linéaire de 4 % à 13 % pour chaque tranche d’âge de 10 ans (p = 0,001) et sur l’ensemble des années financières (p = 0,002). Chez les hommes, la proportion de chirurgies de seconde fracture de la hanche était de 5 % pour chaque tranche d’âge de 10 ans entre 60 et 90 ans et sur l’ensemble des années financières, et augmentait à 8 % pour les hommes de plus de 90 ans sur l’ensemble des années financières (p = 0,20). Ces tendances selon le sexe étaient similaires tant pour les fractures pertrochantériennes que pour les fractures transcervicales.

Conclusion : Les chirurgies de seconde fracture de la hanche représentent une proportion croissante de la totalité des chirurgies de fracture de la hanche et pourraient nécessiter davantage de ressources en soins de santé pour minimiser les résultats moins bons signalés. Les recherches futures devraient déterminer s’il faut davantage de ressources de soins de santé pour la prise en charge de ces patients et l’optimisation de leurs résultats.


Accepted Oct. 11, 2016; Early-released Feb. 1, 2017

Acknowledgements: This study, its authors and manuscript preparation was funded by the Canadian Institutes of Health Research (CIHR), the Centre for Clinical Epidemiology and Evaluation and the Centre for Hip Health and Mobility at the University of British Columbia. The funding bodies had no role in the study design, data collection, analysis, interpretation or manuscript preparation and submission. P. Guy has received grants from CIHR related to this work. He also receives funding from the Natural Sciences and Engineering Research Council of Canada, the Canadian Foundation for Innovation and the British Columbia Specialists Services Committee for work around hip fracture care not related to this manuscript. He has also received fees from the BC Specialists Services Committee (for a provincial quality improvement project on redesign of hip fracture care) and from Stryker Orthopedics (as a product development consultant). He is a board member and shareholder in Traumis Surgical Systems Inc. and a board member of the Canadian Orthopedic Foundation. He also serves on the speakers’ bureaus of AO Trauma North America and Stryker Canada. K. Sheehan is a postdoctoral fellow whose salary is paid with CIHR funding related to this work. All inferences, opinions and conclusions drawn in this manuscript are those of the authors, and do not reflect the opinions or policies of the data steward(s).

Affiliations: From the Department of Orthopedics, University of British Columbia, Vancouver, BC (Guy, Lefaivre); the School of Population and Public Health, University of British Columbia, Vancouver, BC (Sobolev, Sheehan); and the Vancouver Coastal Health Research Institute, Vancouver, BC (Kuramoto).

Competing interests: As above for P. Guy and K. Sheehan. No other competing interests declared.

Contributors: P. Guy, B. Sobolev and K. Lefaivre designed the study, and collected and analyzed the data, which L. Kuramato and K. Sheehan also analyzed. K. Sheehan wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.008616

Correspondence to: K.J. Sheehan, School of Population and Public Health, University of British Columbia, Floor 7, 828 West 10th Ave, Vancouver BC V5Z1M9; sheehakj@mail.ubc.ca