Characteristics and outcomes of non-operatively managed hip fracture patients using the Dutch Hip Fracture Audit (DHFA).

Abstract

OBJECTIVE: This study aims to identify and compare characteristics of hip fracture patients treated non-operatively versus those treated operatively. METHODS: Design: Retrospective cohort study. Setting: Hip fracture population-based study. Patient Selection Criteria: All adult patients with hip fractures (OTA/AO 31A and 31B) were included. Patients with pathological or periprosthetic hip fractures were excluded. Outcome Measures and Comparisons: Patients were categorized according to the type of management (operative vs non-operative) and type of fracture (nondisplaced vs other). Patient- and fracture characteristics associated with non-operative management were analyzed. RESULTS: A total of 94.930 hip fracture patients were included. 3.2% of the patients were treated non-operatively. Patients receiving non-operative management were older (86 years [interquartile range 79-91] vs 81 years [interquartile range 72-87] P <.001), more frequently institutionalized (42.4% vs 17.6%), and were more dependent in activities of daily living (22.2% vs 55.0%) . Various clinical characteristics, including dementia (odds ratio 1.31 [95% confidence interval, 1.18-1.45] P < .001), no functional mobility (odds ratio 4.39 [95% confidence interval 3.14-3.68] P <.001), and KATZ-6-ADL (OR 1.17 [95% CI 1.14-1.20] P < .001) were independently associated with non-operative management. 7-day mortality was 37.6%, and 30-day mortality was 57.1% in patients treated nonoperatively. CONCLUSIONS: The first step in understanding which patients potentially benefit from non-operative management is evaluating the current standard of care. This study provides insight to the current hip fracture population treated non-operatively. These patients are older, have higher percentage of dementia, more dependent and show higher short-term mortality rates. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.