Trends in hip fracture care in the Republic of Ireland from 2013 to 2018:​ results from the Irish Hip Fracture Database

Walsh, M. E.; Ferris, H.; Coughlan, T.; Hurson, C.; Ahern, E.; Sorensen, J.; Brent, L.

Affiliations

¹HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland

²Department of Public Health, HSE South, St. Finbarr’s Hospital, Cork, Ireland

³Strategic Planning and Transformation, Department of Public Health, Mount Kennett House, Henry St, Limerick, Ireland

⁴Department of Medicine, Tallaght University Hospital, Tallaght Dublin 24, D24 NR0A, Ireland

⁵School of Medicine, Trinity College Dublin, Dublin Dublin 2, Ireland

⁶Department of Trauma and Orthopaedics, St Vincent’s University Hospital, Dublin Dublin 4, Ireland

⁷Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland

⁸Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland

⁹National Office of Clinical Audit, Royal College of Surgeons in Ireland, Dublin, Ireland

Abstract and keywords

Summary: Hip fractures continue to be one of the most serious and costly injuries suffered by older people globally. This paper describes the development of a national hip fracture audit and summarises the first 6 years of data from the Republic of Ireland. This can help inform care, standards and outcomes of hip fracture patients.

Introduction: Ireland has one of the highest standardised rates of hip fracture in the world behind northern European countries. The Irish Hip Fracture Database (IHFD) was established in 2012 to drive clinical and organisational improvements in quality and effectiveness of hip fracture care. This paper describes the progression of the IHFD between 2013 and 2018 and identifies trends and areas for improvement.

Methods: The IHFD is a clinically led, web-based audit, with data collected through the national Hospital Inpatient Enquiry (HIPE) electronic system, the principal source of information from publicly funded acute hospitals in Ireland. Eligible cases are aged ≥ 60 years with hip fracture as defined by IHFD or with other specified hip fracture excluding periprosthetic fractures. As of 2015, all 16 trauma-receiving hospitals within Ireland submitted data. Demographics and adherence to six national quality standards are described.

Results: A total of 17,983 cases were included in the analysis. National coverage has increased from 63% in 2013 to 99% in 2018. Demographic characteristics are unchanged, but higher levels of comorbidity are seen. Internal fixation and hemiarthroplasty are the most common modes of surgical repair with two-thirds of cases receiving spinal rather than general anaesthesia. Increasingly patients are being assessed by a geriatrician (11% in 2013 to 69% in 2018) and receive a bone health assessment (65% in 2013 to 84% in 2018).

Conclusion: While some hip fracture standards have improved, further improvements are required to compare favourably internationally. Reduction of surgical delay and ensuring early mobilisation post-operatively are immediate priorities for the IHFD.

Keywords: Hip fracture; Hip fracture registry; International comparison; National clinical audit

Links

DOI: 10.1007/s00198-020-05636-1

PubMed: 32997154

WoS: 000574071200001

History

Received: 2020-07-03

Accepted: 2020-09-09

Online: 2020-09-30

Cited Works (1)

Year	Entry
2012	Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C; IOF Working Group on Epidemiology and Quality of Life. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. September 2012;23(9):2239-2256.