Similar mortality rates in hip fracture patients over the past 31 years

Figures & data

Table 1. Study characteristics

Characteristics	Number of studies
Publication year
1980–1989	8
1990–1999	22
2000–present	40
Geographic location
Europe	58
North America	7
Asia	5
Sample size
< 99	14
100–199	24
200-499	30
> 500	2
Number of centers
1	50
2–4	8
> 5	4
NR	8
Average patient age
60–69	2
70–79	22
80–89	43
NR	3
Type of fracture
Intertrochanteric	28
Femoral neck	42
Intervention
Arthroplasty vs. IF	14
THA vs. IF	4
HA vs. IF	10
THA vs. HA vs. IF	3
Arthroplasty	14
THA vs. THA	2
THA vs. HA	5
HA vs. HA	7
IF vs. IF	38
IF vs. EF	1

NR: not reported;

EF: external fixation;

IF: internal fixation;

THA: total hip arthroplasty;

HA: hemiarthroplasty.

Table 2. Study characteristics of randomized controlled trials assessing intertrochanteric fractures

	Pre-2000(14 trials)	2000+(14 trials)	p-value
Average age	80	80	0.8
Average sample size ^a	158	198	0.4
Sample size range ^a	80–378	58–598
Intervention ^b
Arthroplasty vs. arthroplasty	0	0
Arthroplasty vs. IF	1	1
IF vs. IF	13	12
IF vs. EF	0	1

^a Patients

^b IF: internal fixation; EF: external fixation.

Table 3. Study characteristics of randomized controlled trials assessing femoral neck fractures

	1980s(4 trials)	1990s(12 trials)	2000+(26 trials)	p-value
Average age	77	79	81	0.2
Average sample size ^a	201	218	192	0.8
Sample size range ^a	89–278	43–607	40–455
Intervention ^b
Arthroplasty vs. arthroplasty	1	2	11
Arthroplasty vs. IF	2	2	11
IF vs. IF	1	8	4

^a Patients

^b IF: internal fixation.

Figure 1 Mortality rate 1 year postoperatively for studies published in the 1980s, 1990s, and 2000s. Average 1-year mortality for each time period was calculated using the mortality rate of each trial in that time frame, weighted by sample size.

Figure 2. Mortality rates by fracture type. A. Mortality rates in RCTs assessing treatment of intertrochanteric fractures: mean rates for trials published before 2000 and after 1999. B. Mortality rates in RCTs assessing treatment of femoral neck fractures: mean rates for trials published in the 1980s, 1990s, and 2000s. Number of trials and combined sample size of these trials (in brackets) are given next to each data point.

Table 4. Mortality and reoperation rates in femoral neck and intertrochanteric hip fractures over time

	No. of RCTs	1980s	1990s	2000+	p-value
Mortality rate ^a
Overall	44	24%	23%	21%	0.7
Intertrochanteric	14	34%		23%	0.005 ^b
Neck	30	19%	20%	20%	0.8
Reoperation rate ^a
Overall	19	9.9%	11%	6.6%	0.6

^a Mortality and reoperation rates are weighted by sample size.

^b Statistically significant.