TREATMENT AND SURVIVAL AMONG ELDERLY AMERICANS WITH HIP-FRACTURES - APOPULATION-BASED STUDY

Objectives. This study was undertaken to examine the patterns of treat ment and survival among elderly Americans with hip fracture. Methods. A 5% national sample of Medicare claims was used to identify patients who sustained hip fractures between 1986 and 1989. In comparing treatm ent patterns across regions, direct standardization was used to derive age- and race-adjusted percentages. Logistic regression and Cox regre ssion were used to examine short- and long-term survival. Results. In the United States, 64% of femoral neck fractures were treated with art hroplasty; 90% of pertrochanteric fractures were treated with internal fixation. Higher short- and long-term mortality was associated with b eing male, being older, residing in a nursing home prior to fracture, having a higher comorbidity score, and having a pertrochanteric fractu re. Blocks and Whites had similar 90-day postfracture mortality, but B lacks had a higher mortality later on. For femoral neck fracture, inte rnal fixation has a modestly lower short-term mortality associated wit h it than arthroplasty has. Conclusion. Variation in the treatment of hip fracture was modest. The increased delayed mortality after hip fra cture among Blacks requires further study.