Report calls for hip fracture surgery within 48 hours

22 Jun 2018 | Perioperative Mortality Review Committee

Offering surgery to people with hip fractures within 48 hours could lead to fewer deaths, a report by the Perioperative Mortality Review Committee (POMRC) has found.

The report, published today, found eight percent of people who fracture their hip die within 30 days, increasing to 25 percent at 12 months.

The POMRC reviews deaths related to surgery and anaesthesia that occur within 30 days of an operation. It advises the Health Quality & Safety Commission on how to reduce these deaths and makes recommendations to make surgery safer for patients.

Its seventh report focuses particularly on deaths following treatment for hip fractures. The POMRC looked at data from more than 20,000 patients and has developed a number of recommendations to improve outcomes for people who fracture their hip.

A key recommendation is for all patients who fracture their hip to be offered surgery within 48 hours, if surgery is the best option.

POMRC Chair Dr Tony Williams says hip fractures are serious injuries with serious consequences.

‘Hip fractures are common, and are the leading cause of injury to older people, but they often have life changing effects,’ says Dr Williams.

‘Sadly, hip fractures also have a high mortality rate, and every number in this report represents the loss of a life and the loss of a loved one.’

At the moment about 65 percent of people with hip fractures have surgery within 48 hours, although this varies across New Zealand.

Dr Williams says having surgery within two days of a hip fracture boosts outcomes.

‘Our report found that people who waited longer than 48 hours to have surgery fared worse than those who had it within 48 hours.

‘If surgery is the preferred treatment and there’s no clinical reason why it shouldn’t go ahead, having it quickly is important.’

‘Delays also increase the period of discomfort and uncertainty for patients and their families and whānau, so it’s important every effort is made to operate on these patients as early as practicably possible.’

Dr Williams says it’s pleasing that the number of deaths following hip fracture-related admission is decreasing.

‘This is despite an increasing number of admissions for hip fractures, and more surgeries to repair them.

‘It’s also reassuring to see mortality rates did not vary significantly across DHBs, which suggests New Zealanders are receiving the same standard of care for these fractures wherever they live.’

As well as the 48-hour recommendation for surgery, the report makes a number of other suggestions, both to improve care for people with hip fractures and to prevent them happening in the first place.

These include recommending all people over the age of 65 receive osteoporosis screening and all health care facilities do falls risk assessments for patients over 65.

The report also recommends all people over 65 plan for what to do if they have a fall.

‘Making plans in case of an injury or illness gives people confidence their wishes will be respected,’ says Dr Williams.

‘Developing an advance care plan is a good way to think about what life might look like after a fall or fracture.’

Key findings from the report include the following.

  • Surgery was undertaken in 90.7 percent of patients admitted with hip fractures. The remaining 9.3 percent were given non-surgical treatment, which typically involves bed rest for about six weeks.
  • Delays between admission and surgery increase the mortality rate. The mortality rate following surgery within one day of admission was 6.4 percent, rising to 8.2 percent after four days.
  • Age and gender have an effect on outcomes. Males have a higher overall mortality rate than females. Males over 80 years old had the highest mortality rate.
  • Having other health conditions, poor health and complications were also associated with higher mortality rates following hip fractures.

Last updated 22/06/2018