One in 20 hospitalised with hip fracture in 2020 died before discharge

About one in 20 people who received hospital treatment for a hip fracture in 2020 died before being discharged, with outcomes significantly poorer among those diagnosed with Covid-19 during their stay, a national report states.

The Irish Hip Fracture Database (IHFD)’s review of 2020 includes data on 3,666 cases and states that 185 people hospitalised after a hip fracture died (5 per cent), the same percentage as in 2019.

However, it says 74 hip fracture patients had a Covid-19 diagnosis during the year which “significantly increased” the length of their stay and rate of mortality, which rose to 28 per cent among those with the disease.

The IHFD said the numbers “should be interpreted with caution, and there will be further analysis conducted as more data become available for patients with both hip fracture and Covid-19”.

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Hip fractures are the most common type of injuries sustained by older people and the report states that they “contribute to the spiralling costs of an already overburdened health system”.

Management of older adults with hip fractures in acute hospitals is estimated to cost some €45 million annually and the number recorded is expected to increase in future as life expectancy among the State’s population rises.

The report says 85 per cent of hip fractures in 2020 occurred in the home, the average age of patients was 81 years and that 67 per cent of patients were women.

It says that “overall, hip fracture admissions remained at a high level despite the pandemic”. Quality of care in the area, it says, “remained largely unchanged since 2019” regarding admissions to surgery within 48 hours; patients not developing pressure ulcers; and patients being seen by a geriatrician or advanced nurse practitioner.

National clinical standard

One third of hip fracture patients were admitted to an orthopaedic ward or to surgery from an emergency department within the targeted national clinical standard of four hours, up from a quarter in 2019.

There were also improved discharge rates, with 4 per cent more patients leaving hospitals within a week than in the previous year. The report noted that the mean length of stay for hip fracture patients in 2020 was 17.1 days, and a median of 11 days, which it says “equated to a savings of almost 10,000 acute hospital bed days in 2020 compared to 2019”.

The report notes a slight drop in the number of patients (91 per cent) receiving a bone health assessment in 2020 (down from 94 per cent in 2019) and that 25 per cent of patients waited more than 48 hours for surgery, mostly due to waiting on case reviews and on operating theatre space.

There were also slight gains in getting people mobile more quickly after surgery, with some 85 per cent of patients mobilised (stood up out of bed at a minimum) on the day or day after surgery.

In the report's foreword, Health Service Executive chief clinical officer Dr Colm Henry described 2020 as "an extraordinary year that presented unprecedented challenge to Irish healthcare".

He said it was “all the more extraordinary” that staff had maintained or improved the quality of care to thousands of hip fracture patients.

Dr Henry also noted “gains in the areas of bypass” whereby 94 per cent of patients are brought directly to the operating hospital, only a few years after “we were bringing patients directly to hospitals with no orthopaedic facility”.

He praised elective orthopaedic hospitals and private hospitals who took fracture and other trauma patients in the early phase of the pandemic “to create capacity in the acute hospitals and facilitated the earlier discharge of patients with hip fractures”.