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Lack of compliance with NICE guidance cited for variations in hip fracture surgery

The use of hip fracture surgery varies widely across England, Wales and Northern Ireland, with men and people with high levels of socio-economic deprivation less likely to receive it.

The use of hip fracture surgery varies widely across England, Wales and Northern Ireland, with men and people with high levels of socio-economic deprivation less likely to receive it.

An observational cohort study used the National Hip Fracture Database to look at total hip arthroplasty (THA) for patients with a displaced intracapsular fracture of the femoral neck. It involved patients aged 60 or over who had surgery for a non-pathological displaced intracapsular hip fracture between July 2011 and April 2015.

The study authors concluded that compliance with National Institute for Health and Care Excellence guidance was poor. In 2011, NICE recommended THA should be offered to patients with a displaced intracapsular hip fracture who can walk independently outdoors with no more than a stick as long as they are not cognitively impaired and are medically fit for the procedure.

The study looked at 114,119 patients with hip fracture, of these 11,683 (10.2%) had THA. It found that 32% (6,780) of those who fulfilled the NICE criteria received a THA while 42% of patients who had a THA did not satisfy the NICE criteria.

Older patients were less likely to have THA despite satisfying NICE criteria (odds ratio 0.88), if they were men and also if they had lower socio-economic status.

‘Further efforts are necessary to improve the use of THA for eligible patients and reduce unexplained variation in care for older adults with hip fractures,’ the authors urged.

Reference

Perry DC et al (2016) Inequalities in use of total hip arthroplasty for hip fracture: population based study. BMJ.

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