DIFFERENCES IN MORTALITY AFTER FRACTURE OF HIP - THE EAST-ANGLIAN AUDIT

Objective-To investigate differences between hospitals in clinical man agement of patients admitted With fractured hip and to relate these to mortality at 90 days. Design-A prospective audit of process and outco me of care based on interviews with patients, abstraction from records with standard proforma, and follow up at three months. Data were anal ysed with chi(2) test and forward stepwise regression modelling of mor tality. Setting-All eight hospitals in East Anglia with trauma orthopa edic departments. Patients-580 consecutive patients admitted for fract ure of neck of femur. Main outcome measure-Mortality at 90 days. Resul ts-Patients admitted to each hospital were similar with respect to age , sex, pre-existing illnesses, and activities of daily living before f racture. In all, 560 (97%) were treated surgically, by a range of grad es of surgeon. Two hundred and sixty one patients (45%; range between hospitals 10-91%) received pharmaceutical thromboembolic prophylaxis, 502 (93%; 81-99%) perioperative antibiotic prophylaxis. The incidence of fatal pulmonary emboli differed between patients who received and t hose who did not receive prophylaxis against deep vein thrombosis (P=0 .001). Mortality at 90 days was 18%, differing significantly between h ospitals (5-23%). One hospital had significantly better survival than the others (odds ratio 0 .14; 95% confidence interval 0.04-0.48; P=0.0 016).Conclusions-No single factor or aspect of practice accounted for this protective effect. Lower mortality may be associated with the cum ulative effects of several aspects of the organisation of treatment an d the management of fracture of the hip, including thromboembolic phar maceutical prophylaxis, antibiotic prophylaxis, and early mobilisation .