TY - JOUR
T1 - Variation in care for patients presenting with hip fracture in six high-income countries
T2 - A cross-sectional cohort study
AU - Burrack, Nitzan
AU - Hatfield, Laura A.
AU - Bakx, Pieter
AU - Banerjee, Amitava
AU - Chen, Yu-Chin
AU - Fu, Christina
AU - Godoy Junior, Carlos
AU - Gordon, Michal
AU - Heine, Renaud
AU - Huang, Nicole
AU - Ko, Dennis T.
AU - Lix, Lisa M.
AU - Novack, Victor
AU - Pasea, Laura
AU - Qiu, Feng
AU - Stukel, Therese A.
AU - Uyl-de Groot, Carin
AU - Ravi, Bheeshma
AU - Al-Azazi, Saeed
AU - Weinreb, Gabe
AU - Cram, Peter
AU - Landon, Bruce E.
N1 - Funding Information: This work is supported by a grant from the US National Institute of Aging (R01AG058878) to (Landon/Cram PIs). Dr. Lix receives salary support from a Tier 1 Canada Research Chair. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Dr. Ko is supported by the Jack Tu Chair in Cardiovascular Outcomes, Sunnybrook Hospital, and the University of Toronto. ICES is an independent, nonprofit research institute whose legal status under Ontario's health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement. Ontario datasets were linked using unique encoded identifiers and analyzed at ICES. This work used data adapted from the Statistics Canada Postal Code Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the MOH Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by the MOH and CIHI. The authors acknowledge the Manitoba Centre for Health Policy for using data in the Manitoba Population Research Data Repository under project #2019-056 (HIPC#2019/2020-38). Data used in this study are from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba, and were derived from data provided by Manitoba Health. The results for the Netherlands are based on calculations by Erasmus University using nonpublic microdata available from Statistics Netherlands. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Funding Information: This work is supported by a grant from the US National Institute of Aging (R01AG058878) to (Landon/Cram PIs). Dr. Lix receives salary support from a Tier 1 Canada Research Chair. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long‐Term Care (MLTC). Dr. Ko is supported by the Jack Tu Chair in Cardiovascular Outcomes, Sunnybrook Hospital, and the University of Toronto. ICES is an independent, nonprofit research institute whose legal status under Ontario's health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement. Ontario datasets were linked using unique encoded identifiers and analyzed at ICES. This work used data adapted from the Statistics Canada Postal Code Conversion File, which is based on data licensed from Canada Post Corporation, and/or data adapted from the MOH Postal Code Conversion File, which contains data copied under license from ©Canada Post Corporation and Statistics Canada. Parts of this material are based on data and/or information compiled and provided by the MOH and CIHI. The authors acknowledge the Manitoba Centre for Health Policy for using data in the Manitoba Population Research Data Repository under project #2019‐056 (HIPC#2019/2020‐38). Data used in this study are from the Manitoba Population Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba, and were derived from data provided by Manitoba Health. The results for the Netherlands are based on calculations by Erasmus University using nonpublic microdata available from Statistics Netherlands. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. Publisher Copyright: © 2023 The American Geriatrics Society.
PY - 2023/12
Y1 - 2023/12
N2 - Background: Hip fractures are costly and common in older adults, but there is limited understanding of how treatment patterns and outcomes might differ between countries. Methods: We performed a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalized with hip fracture between 2011 and 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. We examined mortality, hip fracture treatment approaches (total hip arthroplasty [THA], hemiarthroplasty [HA], internal fixation [IF], and nonoperative), and health system performance measures, including hospital length of stay (LOS), 30-day readmission rates, and time-to-surgery. Results: The total number of hip fracture admissions between 2011 and 2018 ranged from 23,941 in Israel to 1,219,696 in the US. In 2018, 30-day mortality varied from 3% (16% at 1 year) in Taiwan to 10% (27%) in the Netherlands. With regards to processes of care, the proportion of hip fractures treated with HA (range 23%–45%) and THA (0.2%–10%) differed widely across countries. For example, in 2018, THA was used to treat approximately 9% of patients in England and Israel but less than 1% in Taiwan. Overall, IF was the most common surgery performed in all countries (40%–60% of patients). IF was used in approximately 60% of patients in the US and Israel, but only 40% in England. In 2018, rates of nonoperative management ranged from 5% of patients in Taiwan to nearly 10% in England. Mean hospital LOS in 2018 ranged from 6.4 days (US) to 18.7 days (England). The 30-day readmission rate in 2018 ranged from 8% (in Canada and the Netherlands) to nearly 18% in England. The mean days to surgery in 2018 ranged from 0.5 days (Israel) to 1.6 days (Canada). Conclusions: We observed substantial between-country variation in mortality, surgical approaches, and health system performance measures. These findings underscore the need for further research to inform evidence-based surgical approaches.
AB - Background: Hip fractures are costly and common in older adults, but there is limited understanding of how treatment patterns and outcomes might differ between countries. Methods: We performed a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalized with hip fracture between 2011 and 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. We examined mortality, hip fracture treatment approaches (total hip arthroplasty [THA], hemiarthroplasty [HA], internal fixation [IF], and nonoperative), and health system performance measures, including hospital length of stay (LOS), 30-day readmission rates, and time-to-surgery. Results: The total number of hip fracture admissions between 2011 and 2018 ranged from 23,941 in Israel to 1,219,696 in the US. In 2018, 30-day mortality varied from 3% (16% at 1 year) in Taiwan to 10% (27%) in the Netherlands. With regards to processes of care, the proportion of hip fractures treated with HA (range 23%–45%) and THA (0.2%–10%) differed widely across countries. For example, in 2018, THA was used to treat approximately 9% of patients in England and Israel but less than 1% in Taiwan. Overall, IF was the most common surgery performed in all countries (40%–60% of patients). IF was used in approximately 60% of patients in the US and Israel, but only 40% in England. In 2018, rates of nonoperative management ranged from 5% of patients in Taiwan to nearly 10% in England. Mean hospital LOS in 2018 ranged from 6.4 days (US) to 18.7 days (England). The 30-day readmission rate in 2018 ranged from 8% (in Canada and the Netherlands) to nearly 18% in England. The mean days to surgery in 2018 ranged from 0.5 days (Israel) to 1.6 days (Canada). Conclusions: We observed substantial between-country variation in mortality, surgical approaches, and health system performance measures. These findings underscore the need for further research to inform evidence-based surgical approaches.
KW - healthcare policy
KW - hip fracture
KW - international comparison
KW - longevity
KW - osteoporosis
UR - http://www.scopus.com/inward/record.url?scp=85167717328&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jgs.18530
DO - https://doi.org/10.1111/jgs.18530
M3 - Article
C2 - 37565425
SN - 0002-8614
VL - 71
SP - 3780
EP - 3791
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 12
ER -