Table 2.
Comparison of implementation and patient characteristics in eight nationwide hip fracture audits
| Rikshöft | SHFA | NHFR | NHFD | IHFR | ANZHFR | DMHFR | DHFA | ||
|---|---|---|---|---|---|---|---|---|---|
| Country of audit | Sweden | Scotland | Norway | UK | Ireland | Australia | New Zealand | Denmark | The Netherlands |
| Year audit started | 1988 | 1993–2008, restart 2015 | 2005 | 2007 | 2012 | 2013 | 2013 | 2016 | |
| Included number of patients in 2017 | 15,062* | 3942 | 8422 | 65,645 | 3159 | 5178 | 730 | 6679 | 11,086 |
| Yearly estimated number of hip fractures | 18,000 | 6000 | – | 65,645 | 3650 | 22,000 | 3803 | 6679 | 19,000 |
| Age for inclusion in audit | 15 | 50 | – | 60 | 60 | 50 | 50 | 65 | 18 |
| Average or median age in years | 82 | 82 | 83 | 83* | 81¶ | 82 | 83 | 83 | 82 |
| Female (%) | 67 | 73 | 70 | 72∆ | 69 | 70 | 68 | 69 | 67 |
| ASA score (%) | |||||||||
| I | – | – | 3 | 2∆ | 2 | 2 | 1 | – | 6 |
| II | 39*◊ | 26*◊ | 32 | 25∆ | 39 | 20 | 22 | – | 30 |
| III | 53* | 53* | 56 | 54∆ | 53 | 56 | 56 | – | 44 |
| IV–V | 8* | 15* | 8 | 14∆ | 7 | 22 | 20 | – | 5 |
| Unknown/missing | – | – | 1 | 4∆ | – | – | – | – | 15 |
| Fracture type (%) | |||||||||
| Femoral neck non-dislocated | 13 | 17* | 13 | 9 | 9 | 17* | 15* | 10* | 14 |
| Femoral neck dislocated | 39 | 36* | 42 | 49 | 43 | 29* | 37* | 45* | 32 |
| Intertrochanteric | 37 | 38* | 30 | 32 | 36 | 46* | 43* | 37* | 33 |
| Subtrochanteric | 8 | 4* | 6 | 6 | 7 | 8* | 5* | 7* | 2 |
| Other/unknown/missing | 3 | 5* | 9 | 4 | 6 | 0* | 0* | 1* | 19 |
| Type of anaesthesia (%) | |||||||||
| General anaesthesia | 5* | 50* | 10 | 41* | 11 | 70* | 56* | – | 30 |
| Spinal anaesthesia | 95* | 44* | 86 | 50* | 58 | 27* | 41* | – | 45 |
| Regional anaesthesia | – | – | – | – | – | 3* | 3* | – | 1 |
| Other/missing | – | 6* | 4 | 9* | 28 | – | – | – | 24ˆ |
| Fracture treatment (%) | |||||||||
| Conservative | – | – | – | 2 | – | – | – | – | 2 |
| Cannulated hip screw | 17* | 2* | 14 | 3 | 2 | 4* | 13* | 10* | 6 |
| Sliding hip screw | 22* | 36* | 22 | 32 | 25 | 19* | 22* | 22* | 13 |
| Intramedullary fixation | 27* | 7* | 17 | 12 | 21 | 36* | 30* | 31* | 38 |
| Hemiarthroplasty | 25* | 44* | 41 | 43 | 45 | 33* | 26* | 25* | 34 |
| Total hip replacement | 9* | 6* | 4 | 8 | 3 | 8* | 9* | 10* | 5 |
| Other/unknown/missing | – | – | 2 | 0 | 2 | – | – | – | 1 |
| Mobility before fracture (%) | |||||||||
| Freely mobile without aids | 43* | 50 | – | 36.4∆ | 46 | 47 | 43 | – | 37 |
| Mobile outdoors with one aid | – | 17 | – | 21.9∆ | – | 12 | 11 | – | 5 |
| Mobile outdoors with two aids or frame | – | 22 | – | 14.8∆ | – | 36 | 35 | – | 26 |
| Some indoor mobility but never goes outside without help | – | 10 | – | 23.7∆ | 14 | – | – | – | 6 |
| No functional mobility (using lower limbs) | – | 1.4 | – | 1.7∆ | 2 | 2 | 2 | – | 2 |
| Unknown/missing | – | – | – | 1.5∆ | – | 3 | 7 | 24 | |
| Living situation before fracture (%) | |||||||||
| Living independently at home | 70* | 75 | – | 81 | 81 | 71 | 76 | 73* | 44 |
| Living independently with help of activities of daily | – | – | – | – | – | – | 16 | ||
| Home care | 26* | 18 | – | 11 | – | 28 | 24 | 19* | 7 |
| Nursing home | – | – | – | 8 | 9 | – | – | – | 10 |
| Nursing home with rehabilitation | – | – | – | – | – | – | – | – | 1 |
| Different living situation | – | – | – | – | 9 | – | – | – | 2 |
| Unknown/missing | – | – | – | – | – | – | – | – | 21 |
Source is 2017 annual report of audit; if 2017 annual report was not available, the 2016 annual report was taken. The year of the annual report should be placed after the full audit name.
Rikshöft (Sweden) 2016, SHFA = Scottish Hip Fracture Audit 2017, NHFR = Norwegian Hip Fracture Register 2017, NHFD = National Hip Fracture Database 2017 (United Kingdom minus Scotland), Irish Hip Fracture Audit 2016, ANZHFR = Australian and New Zealand Hip Fracture Registry 2017, DMHFR = Danish Multidisciplinary Hip Fracture Registry 2017, DHFA= Dutch Hip Fracture Audit 2017.
*Source: [41]
∆Source: NHFD annual report 2016
◊ASA I and ASA II together
¶Average age is 79 for men and 81 for women
^Other anaesthesia in the DHFA is general and regional anaesthesia (2%), general and spinal anaesthesia (1.5%), spinal and regional anaesthesia (4.9%), and missing (15%)