National registries in UK, Australia and New Zealand report progress and gaps in hip fracture care

National hip fracture databases play a vital role in identifying care gaps which could reduce mortality and morbidity in the increasing numbers of hip fracture patients worldwide.

In many countries, there is a lack of information about the care that hip patients receive during and after hospitalization. The establishment of a national hip fracture registry provides critical information regarding patient characteristics, operative practices such as time to surgery, and postoperative outcomes. All of this data can be analysed, interpreted, and effectively used to improve patient care in order to reduce the high burden of morbidity and mortality following hip fractures.

The UK National Hip Fracture Database represents an established example of the potential for such large-scale clinical registries to help understand and improve hip fracture care. On September 14, 2017 the UK’s National Hip Fracture Database (NHFD) released its 9th annual report  containing analysis of 2016 data. The report analyses the process and outcomes of care of nearly 65,000 people who presented with a hip fracture across 177 hospitals. Considerable good practice within inpatient care is reported, with “the majority of patients getting prompt surgery, specialist geriatric assessment and consideration of their nutritional status”. However the report also states that, across the country:

Nearly 40% of patients are still not receiving the full package of care that represents best practice and are missing out on important clinical assessments that will improve their rehabilitation and recovery after this serious injury.”

The Australian and New Zealand (ANZ) Hip Fracture Registry has also just recently published its findings. For the first time, the report incorporates patient health outcomes beyond discharge, including information on rates of death and on walking ability as 30 day and 120-day outcomes for those sites which collected this information.

 > View the ANZHFR Annual Report

Paul Mitchell, Chair of Osteoporosis New Zealand, stated:

In New Zealand, we are on track to have all hospitals participating by the end of this year. There is clearly work to be done to improve post-hip fracture rates of osteoporosis-specific therapy, but having the data enables us to know where we are at, and where we need to be.”

In its introduction, the ANZHFR Annual Report emphasizes that mortality and morbidity as a result of a hip fracture is high. Five per cent will die in hospital; over 10% will be newly discharged to an aged care facility; more than 50% will still experience a mobility-related disability 12 months after injury and another 15-20% will have died in the year after discharge from hospital. Research shows that effective secondary preventative care after fracture, such as osteoporosis assessment and treatment, and falls reduction interventions, is not routinely delivered. This care gap leaves hip fracture survivors with an increased risk of subsequent falls and fractures that are associated with increased mortality and loss of societal contributions.