The Danish Multidisciplinary Hip Fracture Registry 13-Year Results from a Population-Based Cohort of Hip Fracture Patients

Figures & data

Figure 1 Types of collum femoris fractures included in the multidisciplinary hip fracture registry.

Table 1 The Quality Indicators in the Multidisciplinary Hip Fracture Registry Through the Years

	Indicator Area	Indicator	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
Process Performance Measures	Pain assessment	Daily systematic pain assessment using a visual analog scale or a numeric rating scale at rest and during mobilization	+	+	+	+	+	+	+	+	+
	Mobilization within 24 hours	Being mobilized within 24 hours postoperatively, defined as assisting the patient from bed rest to walking or rest in a chair					+	+	+	+	+	+^a	+	+	+
	Assessment of nutrition risk	Assessment of patients BMI and nutritional risk within two days after admission.	+	+	+	+						+	+	+	+
	Osteoporotic medication	Evaluation of need of anti-osteoporotic medications, which includes continued anti-osteoporosis medication, no indication for treatment due to cancer or psychiatric condition or referring to DEXA scan					+	+	+	+	+	+	+	+	+
	Fall prevention	Initiation of treatment to prevent future fall accidents, including a fall risk assessment to account for co-existing medical conditions, medication, functional disability, symptoms from the central nervous system, musculoskeletal system and cardiopulmonary status					+	+	+	+	+	+	+	+	+
	Prevention of osteoporotic fractures	Initiation of treatment includes ordination of any anti-osteoporotic medications or calcium and d-vitamin or hip protectors	+	+	+	+
	Post discharge rehabilitation program	Post discharge rehabilitation program including assessment of activities of daily living (ADL) with a validated test before the fracture and again before discharge		+	+	+	+	+	+	+	+	+	+	+	+
	Assessment of functional level prior to admission	Basic mobility assessment using a validated test such as Cumulated Ambulation Score (CAS), Barthel 20, Functional Recovery score or New Mobility score. From 2013, only CAS is measured at admission.	+	+	+	+	+^a	+	+	+^a	+	+	+	+	+
	Assessment of functional level at discharge	Basic mobility assessment using a validated test such as Cumulated Ambulation Score (CAS), Barthel 20, Functional Recovery score or New Mobility score. From 2013, only CAS is measured prior to discharge	+	+	+	+	+	+	+	+	+	+	+	+	+
	Surgical delay	Patient had surgery within 24 hours after admission to hospital (from 2016, admission time was changed to arrival time)										+	+	+	+
		Patient had surgery within 36 hours after admission to hospital (from 2016, admission time was changed to arrival time)										+	+	+	+
	Preoperative optimization	Assessment by a medical specialist intending to do a preoperative optimization plan within four hours after arrival to the hospital.											+	+	+
Outcome Measures	30-day survival	Survival within 30 days after surgery date	+	+	+	+	+	+	+	+	+	+	+	+	+
	Reoperation within two years after osteosynthesis	Reoperation within two years among patients, who have had a medial femoral fracture treated with osteosynthesis regardless of fracture displacement	+	+	+	+	+	+	+	+	+	+	+	+	+
		Reoperation within two years among patients, who have had a medial undisplaced femoral fracture treated with osteosynthesis.	+	+	+	+	+	+	+	+	+	+	+	+	+
		Reoperation within two years among patients, who have had a medial displaced femoral fracture treated with osteosynthesis regardless of fracture displacement	+	+	+	+	+	+	+	+	+	+	+	+	+
		Reoperation within two years among patients, who have had a pertrochanter or subtrochanter femoral fracture treated with osteosynthesis.
	Reoperation within two years after alloplastic	Reoperation within two years among patients, who have had an alloplastic regardless of fracture type	+	+	+	+	+	+	+	+	+	+	+	+	+
	Reoperation within two years due to infection	Reoperation within two years due to deep infection	+	+	+	+	+	+	+	+	+	+	+	+	+
	Acute readmission within 30-days after discharge	Acute readmission to any Danish hospital regardless of cause within 30 days after discharge with the hip fracture diagnosis											+	+	+

Note: ^aChange in data definitions.

Table 2 Patient Characteristics of the Hip Fracture Population from 2006 to 2018

	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
Number of Admissions	6456	6566	7423	7155	5143	7158	6801	6904	6611	6789	6679	6502	6374
Age, median year (Q1-Q3)	83	83	84	84	83 (77–89)	83(77–89)	84(78–89)	84(77–89)	84(77–89)	83(77–89)	84(77–89)	83(77–89)	83(76–89)
Gender:
Men	1686	1784	1998	1939	1413	2038	1970	1988	1867	2021	2060	2035	2045
Women	4770	4782	5425	5216	3730	5120	4831	4916	4744	4768	4619	4467	4329
Residence (2005–2009):
Living together with another adult	1673	1686	1969	1914
Living alone in one’s own home	3244	3344	3946	3802
Other including living in a nursing home or other institution	1060	1216	1256	1158
Missing	479	320	252	281
Residence (2010→)
Own home					2871	4791	4540	4717	4457	4599	4609	4400	4501
Own home affiliated with an institution					378	424	385	405	360	378	391	257	217
Institution					871	1311	1227	1357	1182	1080	1147	1112	1136
Missing					1023	632	649	425	612	732	532	733	520
ASA: (2006–2009)
0	602	543	570	546
1	2977	3189	3538	3582
2	2091	2207	2575	2383
4	338	357	336	311
5	10	12	12	9
Missing	438	258	392	324
CCI (2010→):
None 0 point					2023	2800		2544	2399	2512	2420	2394	2307
Mild 1 point					1201	1723		1718	1591	1510	1554	1497	1441
Moderate 2 points					903	1266		1192	1154	1229	1199	1182	1151
Severe ≥ 3 points					1016	1369		1450	1467	1538	1506	1429	1475
BMI (2010→):
< 19: Underweight					586	961	958	1030	943	881	1426	795	829
20–25: Normal					1770	2919	2850	2916	2811	2757	2644	2428	2327
26–29: Overweight					871	1540	1383	1455	1410	1484	1476	1394	1334
>30: Obese					323	412	375	429	399	402	478	461	430
Missing					1593	1326	1235	1074	1048	1055	655	1424	1454
Fracture Displacement
Displaced	4707	5375	6184	5880	3142	5314	4985	5202	4845	5081	4811	4266	3792
Undisplaced	932	1149	1209	1243	549	835	787	828	744	680	657	542	464
Unspecified	817	42	30	32	1452	1009	1029	874	1022	1028	1211	1694	2118
Type of Fracture
Medial femoral neck	3253	3334	3786	3597	2662	3671	3619	3815	3630	3781	3691	3498	3371
Pertrochanteric	2628	2721	3075	2966	2093	2949	2704	2593	2714	2526	2502	2495	2527
Subtrochanteric	410	484	551	577	388	538	478	496	526	482	486	509	476
Missing	165	27	11	15
Type of Surgery
Osteosynthesis	4597	4734	5309	5018	3538	4877	4435	4464	4336	4365	4325	4176	4082
Hemi/total arthroplasty	1572	1611	1945	1964	1605	2281	2366	2440	2275	2424	2354	2326	2292
Missing	287	221	169	173
Alcohol Intake (2006–2009)
≤ 14/21 per week for women/men	4405	4801	5759	5307
>14/21 units per week for women/men	188	230	272	230
Missing	1863	1535	1392	1618
Smoking Habits (2006–2009)
Current	1366	1412	1657	1532
Former	1001	1151	1422	1401
Never	2180	2431	2837	2516
Missing	1909	1572	1507	1706
Time to Surgery (hours)^a
<24 hours	3293	3405	3855	3901	2858	3899	4299	4392	4377
24-48 hours	2197	2104	2502	2286	1584	2361	1876	1890	1827
> 48 hours	759	781	858	714	693	893	626	617	402
Missing	207	276	208	254	8	5		5	5
Region
North Denmark		925	872	852	606	913	844	765	783	769	800	804	702
Central Denmark		1607	1675	1628	1097	1513	1455	1509	1421	1454	1449	1419	1428
Southern Denmark		1844	1818	1757	1196	1714	1566	1566	1607	1556	1559	1566	1670
Capital region		1343	1780	1791	1434	1949	1898	1917	1777	1871	1770	1618	1495
Zeeland region		1079	1142	1127	810	1069	1038	1147	1023	1139	1101	1095	1079

Note: ^aFrom 2015 and onward time to surgery is collected as a process performance measure.

Abbreviations: BMI, Body Mass Index; ASA, American Society of Anesthesiologists’ classification score; CCI, Charlson Comorbidity Index.

Figure 2 Proportion of patients in percent that have fulfilled the individual process performance measures over time.

Figure 3 Proportion of patients with 30-day survival and readmission and reoperation within two years over time.