Archives of Osteoporosis

, 8:150 | Cite as

Changes in hip fracture incidence, mortality and length of stay over the last decade in an Australian major trauma centre

  • Nicole Williams
  • Ben M. Hardy
  • Seth Tarrant
  • Natalie Enninghorst
  • John Attia
  • Christopher Oldmeadow
  • Zsolt J. BaloghEmail author
Original Article



The aim of this study was to describe the population-based longitudinal trends in incidence, 30-day mortality and length of stay of hip fracture patients in a tertiary referral trauma centre in Newcastle, New South Wales, Australia, and identify the factors associated with increased 30-day mortality.


A retrospective database and chart review was conducted to patients aged ≥65 years with a diagnosis of femoral neck or pertrochanteric fracture admitted to the John Hunter Hospital between 01 January 2002 and 30 December 2011. The main outcome measure was 30-day mortality; secondary outcome was acute length of stay.


There were 4,269 eligible patients (427 ± 20 per year) with hip fractures over the 10-year study period. The absolute incidence increased slightly (p = 0.1) but the age-adjusted rate decreased (p ≤ 0.0001). The average age (83.5 ± 7.1 years) and percentage of females (73.7 %) did not change. Length of stay increased by a factor of 2.5 % per year (p < 0.0001). Thirty-day mortality decreased from 12.3 % in 2002 to 8.20 % in 2011 (p = 0.0008). Independent risk factors associated with increased 30-day mortality were longer admissions (p < 0.0001), increased age (p = 0.005), dementia (p = 0.01), male gender (p < 0.0001), higher American Society of Anaesthesiologists score (p < 0.0001), and longer time to operating theatre (p = 0.002).


Despite the relative ageing of our population, a decrease in the age-standardised rate of fractured hip in elderly patients has seen the number of admissions remain unchanged in our institution from 2002 to 2011. There was a decrease in 30-day mortality, while length of stay increased.


Hip fracture Geriatric fractures Fragility fractures Low-energy falls 



The authors would like to thank Rhonda Walker, Cardiac and Stroke Outcomes Unit, Hunter New England Area Health Service and Denis McKay, Clinical Information Service, John Hunter Hospital for their assistance with data linkage.

Conflicts of interest



  1. 1.
    Hollingworth W, Todd CJ, Parker MJ (1996) The cost of treating hip fractures in the twenty-first century: short report. Osteoporos Int 6(Suppl 2):13–5PubMedCrossRefGoogle Scholar
  2. 2.
    Sanders KM et al (1999) Health burden of hip and other fractures in Australia beyond 2000. Projections based on the Geelong Osteoporosis Study. Med J Aust 170(10):467–70PubMedGoogle Scholar
  3. 3.
    Boufous S, Finch CF, Lord SR (2004) Incidence of hip fracture in New South Wales: are our efforts having an effect? Med J Aust 180(12):623–6PubMedGoogle Scholar
  4. 4.
    Mak JC et al (2010) Evidence-based guidelines for the management of hip fractures in older persons: an update. Med J Aust 192(1):37–41PubMedGoogle Scholar
  5. 5.
    Royal College of Physicians of London, Bone and Tooth Society (2000) Osteoporosis: clinical guidelines for prevention and treatment: update on pharmacological interventions and an algorithm for management. Royal College of Physicians of London, LondonGoogle Scholar
  6. 6.
    Cooper C et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277–88PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    National Regional Profile: Newcastle (Statistical Subdivision) (2011) CanberraGoogle Scholar
  8. 8.
    Hunter Valley Research Foundation (2012) Hunter Valley Research Foundation [cited 25 January 2012]; Available from:
  9. 9.
    Rae HC et al (2007) Delay to surgery and mortality after hip fracture. ANZ J Surg 77(10):889–91PubMedCrossRefGoogle Scholar
  10. 10.
    Simunovic N et al (2010) Effect of early surgery after hip fracture on mortality and complications: systematic review and meta-analysis. CMAJ 182(15):1609–16PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Lau TW et al (2010) Geriatric hip fracture clinical pathway: the Hong Kong experience. Osteoporos Int 21(Suppl 4):S627–36PubMedCrossRefGoogle Scholar
  12. 12.
    Brauer CA et al (2009) Incidence and mortality of hip fractures in the United States. JAMA 302(14):1573–9PubMedCrossRefGoogle Scholar
  13. 13.
    White SM, Rashid N, Chakladar A (2009) An analysis of renal dysfunction in 1511 patients with fractured neck of femur: the implications for peri-operative analgesia. Anaesthesia 64(10):1061–5PubMedCrossRefGoogle Scholar
  14. 14.
    Komarasamy B et al (2007) Mortality following hip fracture surgery in patients with recent myocardial infarction. Ann R Coll Surg Engl 89(5):521–5PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Donegan DJ et al (2010) Use of medical comorbidities to predict complications after hip fracture surgery in the elderly. J Bone Joint Surg Am 92(4):807–13PubMedCrossRefGoogle Scholar
  16. 16.
    Moja L et al (2012) Timing matters in hip fracture surgery: patients operated within 48 hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One 7(10):e46175PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Lemos D et al (2009) Dedicated orthopedic trauma theatres: effect on morbidity and mortality in a single trauma centre. Can J Surg 52(2):87–91PubMedCentralPubMedGoogle Scholar
  18. 18.
    Choong PF et al (2000) Clinical pathway for fractured neck of femur: a prospective, controlled study. Med J Aust 172(9):423–6PubMedGoogle Scholar
  19. 19.
    Evans JG, Seagroatt V, Goldacre MJ (1997) Secular trends in proximal femoral fracture, Oxford record linkage study area and England 1968–86. J Epidemiol Community Health 51(4):424–9PubMedCrossRefGoogle Scholar
  20. 20.
    Wong TH et al (2012) Impact of consultant operative supervision and surgical mortality in Australia. ANZ J Surg 82(12):895–901PubMedCrossRefGoogle Scholar
  21. 21.
    Neary WD et al (2006) Identifying high-risk patients undergoing urgent and emergency surgery. Ann R Coll Surg Engl 88(2):151–6PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Parker MJ, Handoll HH, Griffiths R (2004) Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev 4, CD000521PubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • Nicole Williams
    • 1
  • Ben M. Hardy
    • 2
  • Seth Tarrant
    • 3
  • Natalie Enninghorst
    • 4
  • John Attia
    • 5
  • Christopher Oldmeadow
    • 2
  • Zsolt J. Balogh
    • 6
    Email author
  1. 1.Orthopaedics and TraumaWomen’s and Children’s Hospital and University of AdelaideAdelaideAustralia
  2. 2.School of Medicine and Public HealthUniversity of NewcastleNewcastleAustralia
  3. 3.Department of Orthopaedic SurgeryJohn Hunter HospitalNewcastleAustralia
  4. 4.Department of TraumatologyJohn Hunter HospitalNewcastleAustralia
  5. 5.School of Medicine and Public Health and Department of MedicineUniversity of Newcastle and John Hunter HospitalNewcastleAustralia
  6. 6.Department of TraumatologyJohn Hunter Hospital and University of NewcastleNewcastleAustralia

Personalised recommendations