Deaths from Fracture Neck of Femur

Age standardised Death rate Fracture of Femur

age 65-84 2003-2005

0

2

4

6

8

10

12

14

16

YORKS & H

UMBER

SOUTH WEST

SOUTH EAST

EAST OF E

NGLAND

LONDON

NORTH E

AST

NORTH W

EST

EAST MID

LANDS

WEST M

IDLANDS

De

ath

ra

te p

er

10

0,0

00 Men

Women

Age standardised Death rate Fracture of Femur

age 85+ 2003-2005

0

50

100

150

200

250

300

YORKS & H

UMBER

LONDON

SOUTH EAST

SOUTH WEST

EAST OF E

NGLAND

NORTH W

EST

NORTH E

AST

EAST MID

LANDS

WEST M

IDLANDS

De

ath

ra

te p

er

10

0,0

00

MenWomen

Age specific Death rate Fracture of Femur

England & Wales 2003-2005

0

50

100

150

200

250

300

350

50-54 60-64 70-74 80-84 90+

Rat

e p

er 1

00,0

00

Men

Women

Age standardised

Death rate Fracture of FemurAge 65+ England & Wales

0

50

100

150

200

250

300

1991 1993 1995 1997 1999 2001 2003 2005

Ag

e st

and

ard

ised

rat

e p

er 1

00,0

00

Men

Women

ICD codes Deaths Fracture FemurEngland & Wales 2005

S72.0 Neck 2568

S72.1 Pertrochanteric 37

S72.2 Subtrochanteric 7

S72.3 Shaft 19

S72.4 Lower 37

S72.7 Multiple 4

S72.9 Unspecified 292

S72 Total Femur 2964

Possible reasons for high death rate

• High incidence

• High fatality rate– Inferior care– Some other reason

• Diagnostic or coding artefact

Age standardised

Admission rate Fracture Neck of FemurAge 65+ 2004/05

0

200

400

600

800

1000

SOUTH W

EST

WEST M

IDLANDS

NORTH E

AST

EAST OF E

NGLAND

EAST MID

LANDS

SOUTH E

AST

NORTH W

EST

YORKS & H

UMBER

LONDON

Ag

e S

tan

dar

dis

ed r

ate

per

100

,000

Men

Women

Hospital Admission rate

Fracture neck of FemurEngland 2005/06

0

500

1000

1500

2000

2500

3000

3500

50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+

Men

Women

Trends in Hospital admissions for Fracture Neck of Femur

England & Wales 1959-1977Source Lewis AF BMJ 1981; 283, 1217-1220

0

5

10

15

20

25

30

35

40

45

1955 1960 1965 1970 1975 1980

# A

dm

issi

on

s (t

ho

usa

nd

s)

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

All

Ad

mis

sio

ns

(th

ou

san

ds)

FNOF Other Fem # All Admissions

Age standardised Admission rate Fracture Neck of Femur

Age 65+

0

100

200

300

400

500

600

700

800

2000-01 2001-02 2002-03 2003-04 2004-05

Sta

nd

ard

ised

rat

e p

er 1

00,0

00

Females

England

West Midlands

Males

England

West Midlands

Indirectly age standardised Death rate within 30 days of admission for Fracture Neck of Femur 2003-2004

0

2500

5000

7500

10000

12500

EAST MID

LANDS

LONDON

SOUTH W

EST

NORTH E

AST

SOUTH E

AST

YORKS & H

UMBER

EAST OF E

NGLAND

WEST M

IDLANDS

NORTH W

EST

Ag

e S

tan

dar

dis

ed R

ate

per

100

,000

Indirectly age standardised

Percent returning to usual residence after Fracture Neck of Femur 2003/04

0

10

20

30

40

50

60

WEST M

IDLANDS

NORTH WEST

SOUTH WEST

SOUTH EAST

LONDON

NORTH EAST

EAST MID

LANDS

EAST OF E

NGLAND

YORKS & H

UMBER

Sta

nd

ard

ised

per

cen

t

Indirectly age standardised % Operated on within 48 hrs of admission

for Fracture Neck of Femur 2003/04

0

10

20

30

40

50

NORTH W

EST

EAST MID

LANDS

SOUTH W

EST

NORTH E

AST

SOUTH E

AST

YORKS & H

UMBER

LONDON

WEST M

IDLANDS

EAST OF E

NGLAND

Sta

nd

ard

ised

Per

cen

t

Classification of hip

fractures

Operative management of Fracture Neck of Femur 2005/06

0%

20%

40%

60%

80%

100%

NORTH EAST

NORTH WEST

YORKS & H

UMBER

EAST MID

LANDS

WEST M

IDLANDS

EAST OF E

NGLAND

LONDON

SOUTH EAST

SOUTH WEST

No operation

Prostheticreplacement

Primary reductionW19-W20-W21

Closed reductionW24, W25, W26

Ratio of Death and Admission rates age specific

Fractured Neck of Femur England 2004/05

0

500

1000

1500

2000

2500

45-49 55-59 65-69 75-79 85+

Rat

e p

er 1

00,0

00

0

0.05

0.1

0.15

0.2

0.25

Dea

th A

dm

issi

on

Rat

io

Deaths

Admissions

Ratio

Fatality rate after Admission for Fracture Neck of Femur

Record linkage studySource Goldacre MJ, Roberts SE, Yeates BMJ 2002; 325, 868-869

All Deaths Mention of FNOF

Within 30 days 10.5% 4.5%

Within 90 days 18.8% 6.9%

Within 180 days 24.6% 7.7%

nchod Data specification Fracture Neck of Femur

“ Cause data for fractures should be used with great care because of the effects of artefactual local differences resulting from variations in certification procedures between coroners. Deaths caused by fracture neck of femur are also under recorded because there are a number of alternatives for classifying such deaths. For these reasons, variations between areas should be interpreted with caution”