Mortality Registration in Patients with a Proximal Femoral Fracture Admitted to a Surgical Ward

Abstract

Background: A mortality registration system for patients who died after admission to a surgical ward with a hip fracture was developed. The aim of this study was to verify whether performing autopsies is necessary to obtain an accurate picture of the clinical course of these patients.

Methods: The mortality registration system was used to classify causes of death, to evaluate shortcomings in treatment, and to determine the extent of agreement between clinical and autopsy findings.

Results: Between 1989 and 1998, 101 of the 1,240 patients (8%) admitted with a hip fracture died in hospital. Most of these patients (61%) died of postoperative complications, of which pneumonia was the most common. Shortcomings in medical treatment were observed in 16 of the 101 deaths (16%). Permission to perform an autopsy was given by the relatives of 46 patients (46%); in three patients (7%) there was a disparity between clinical and autopsy findings.

Conclusions: The disparity between clinical and autopsy findings depends on the accuracy of the preoperative diagnosis and the complexity of the postoperative events. In this selected group of hip fracture patients, the causes of death and the shortcomings in medical care could be identified without the help of autopsy data.