Mortality following hip fracture: Trends and geographical variations over the last 40 years

We propose a classification system which stratifies the risks of peri-operative morbidity and mortality for hip fracture patients.The system is based on our prospective audit findings and uses co-morbidities and fracture patterns to rank patients on admission.It is a four-part clinical stratification:• Complex 0 (C0).Hip repair of a non-complex fracture pattern in an otherwise fit, healthy patient.• Complex I (CI).A fit, healthy patient with a complex hip fracture pattern.• Complex II (CII).Medically unfit patient with a noncomplex hip fracture.• Complex III (CIII).Medically unfit patient with a complex hip fracture.Patients were stratified as above and the following factors recorded: age, length of stay, time to theatre and reason for delay, mental state examination score (MSE) on admission, number of co-morbidities, in-hospital complication rate and 30-day mortality.Chi-square was performed on co-morbidity, MSE and theatre times with AVOVA used for age and length of stay data.Significant differences were found between all groups.We have validated this universal classification by retrospectively applying it to the patients in our audit database and comparing measured outcomes.This enables a clearer allocation of medical resources to those patients in most need early in their care pathway.It also facilitates audit and aids the evaluation of expensive multidisciplinary care whilst being able to differentiate and justify patient outcomes between health regions based on the complexity of their patient demographic.