Geographic variation in hip fracture surgery rate, care quality and outcomes: a comparison between national registries in Ireland and Denmark,Archives of Osteoporosis

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Geographic variation in hip fracture surgery rate, care quality and outcomes: a comparison between national registries in Ireland and Denmark
Archives of Osteoporosis ( IF 3.1 ) Pub Date : 2022-09-26 , DOI: 10.1007/s11657-022-01169-8
Mary E Walsh ₁ , Jan Sorensen ₂ , Catherine Blake ₁ , Søren Paaske Johnsen ₃ , Pia Kjær Kristensen ₄

Affiliation

Summary

Ireland and Denmark have similar hip fracture surgery rates but differences in care quality indicators and patterns of intracapsular fracture repair. Very high variation in total hip arthroplasty rate within both countries and higher observed early mortality in Denmark require further investigation.

Purpose

To explore and compare geographic variation of hip fracture surgery rate, care quality and outcomes in Ireland and Denmark.

Methods

Patients aged ≥ 65 years with surgically treated hip fracture were included from the Irish Hip Fracture Database (years = 2017–2020, n = 12,904) and the Danish Multidisciplinary Hip Fracture Registry (years = 2016–2017, n = 12,924). The age and sex standardised rate of hip fracture surgery and the proportion of patients with seven process quality indicators, three surgery types and four outcomes were calculated. Systematic components of variation (SCV) were calculated based on hospital area (6 Irish hospital groups, 5 Danish regions).

Results

The age and sex standardised rate of hip fracture surgery per 1000 older population in 2017 was 4.7 (95% CI = 4.4–5.1) in Ireland and 5.3 (95% CI = 5.1–5.5) in Denmark. Ireland had lower rates of surgery within 36 h (59% versus 84%), nutritional assessment (27% versus 84%) and pre-discharge mobility recording (52% versus 92%). Patterns of intracapsular fracture repair also differed between countries (hemiarthroplasty: Ireland = 85%, Denmark = 52%). Both countries had very high variation for total hip arthroplasty (THA) provision (SCV Ireland = 10.6, Denmark = 97.9). Ireland had longer hospital stays (median 12 versus 7 days), but lower 7-day (1.0% versus 3.1%) and 14-day (2.0% versus 5.5%) mortality.

Conclusion

Ireland and Denmark have similar hip fracture surgery rates, but differences in care quality, surgery patterns and outcomes. High variation in THA provision and observed differences in mortality require further exploration. In Ireland, there is scope for improvement regarding early surgery, mobility, nutrition assessment and improved post-discharge follow-up.

中文翻译：

髋部骨折手术率、护理质量和结果的地理差异：爱尔兰和丹麦国家登记处的比较

概括

爱尔兰和丹麦的髋部骨折手术率相似，但在护理质量指标和囊内骨折修复模式方面存在差异。这两个国家的全髋关节置换率差异很大，丹麦观察到的早期死亡率较高，需要进一步调查。

目的

探讨和比较爱尔兰和丹麦髋部骨折手术率、护理质量和结果的地理差异。

方法

爱尔兰髋部骨折数据库（年 = 2017-2020， n = 12,904）和丹麦多学科髋部骨折登记处（年 = 2016-2017，n = 12,924）包括年龄≥ 65 岁并接受手术治疗的髋部骨折患者。统计7项过程质量指标、3种手术类型、4种结局的髋部骨折手术年龄、性别标准化率及患者比例。变异的系统成分 (SCV) 是根据医院区域（6 个爱尔兰医院组，5 个丹麦地区）计算的。

结果

2017 年，爱尔兰每 1000 名老年人的髋部骨折手术年龄和性别标准化率为 4.7（95% CI = 4.4-5.1），丹麦为 5.3（95% CI = 5.1-5.5）。爱尔兰在 36 小时内进行手术（59% 对 84%）、营养评估（27% 对 84%）和出院前活动记录（52% 对 92%）的比例较低。囊内骨折修复的模式也因国家而异（股骨头置换术：爱尔兰 = 85%，丹麦 = 52%）。这两个国家在全髋关节置换术 (THA) 方面的差异很大（SCV 爱尔兰 = 10.6，丹麦 = 97.9）。爱尔兰的住院时间更长（中位数为 12 天对 7 天），但 7 天（1.0% 对 3.1%）和 14 天（2.0% 对 5.5%）死亡率较低。