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 Quebec, 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%. Inpatient death has decreased by 4% each year.


CONCLUSIONS
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.
Département d'ergothérapie, Université du Québec à Trois-Rivières, Québec City, Canada. marie-josee.sirois.@uqtr.ca
Marie-Josée
MJ
Sirois
Maxime
M
Côté
Stéphane
S
Pelet
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D015577:Geriatric Assessment; D017048:Health Care Costs; D006620:Hip Fractures / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D011792:Quebec; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014193:Trauma Centers / Q000706:statistics & numerical data