The Burden of Hospitalized Hip Fractures: Patterns of Admissions in a Level I Trauma Center Over 20 Years

Background: To describe trends over 20 years in (1) number of admissions for hip fracture, (2) patients' demographics, type of fractures sustained by the patients, and their health status at admission, (3) surgical delays, and (4) acute care outcomes. Methods: This trend was a study conducted in a Level I trauma center in Que- bec, Canada. All patients (n = 3174) aged 65 and older, admitted with a hip fracture between 1985 and 2005 were included. Outcome measures were: number of admissions, age, gender, comorbidities at admission, surgical delays, postsurgical complications, inpatient mortality, discharge destinations. Results: From 1985 to 2005, the number of admissions increased from 56 to 271, age at admission has increased by 2 years both in men and women (p < 0.01), women/men proportion has remained stable (3.2) over time. The adjusted proportions of minor and severe comorbidities at admission increased by 13% and 5% yearly (p < 0.01). Surgical delays decreased from 4.7 days ± 16.5 days to 0.9 days ± 1.9 days (p < 0.01). Acute care length of stay has drastically decreased from 37.0 days ± 70.9 days to 16.7 days ± 14.2 days (p < 0.01). Although severe postsurgical complications did not increase over time, the proportion of patients suffering from minor postsurgical complications increased by 22%. In-patient death has decreased by 4% each year. Conclusion: The tremendous increase in the volume of older and sicker patients admitted for hip fracture has put an enormous demand on our Level I trauma center. The changes in clinical management implemented to face this challenge have helped improve acute care outcomes.