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Hip fractures in South Africa: mortality outcomes over 12 months post-fracture

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Abstract

Summary

With increased urbanisation and longevity in sub-Saharan Africa, the burden of osteoporosis and resultant hip fractures (HF) has increased. This study shows that 1 in 3 subjects dies post-HF, and that there are significant delays and barriers to surgery, reflecting the need to prioritise HF care in South Africa.

Purpose

The outcomes following hip fractures are unknown in sub-Saharan Africa. This study aimed to quantify the mortality rate (MR) following hip fractures and to identify predictors of mortality over 1 year.

Methods

In this cohort study, demographic, clinical, and biochemical characteristics of consecutive patients with low trauma hip fractures, admitted to the five public sector hospitals in eThekwini (formerly Durban), were recorded. Cox regression analyses identified predictors of mortality at 30 days and 1 year.

Results

In the 200 hip fracture patients studied, the mean age was 74.3 years (SD ± 8.8) and 72% were female. Hospital presentation was often delayed, only 15.5% presented on the day of fracture. At admission, 69.5% were anaemic, 42% had hyponatraemia, 34.5% raised creatinine, and 58.5% hypoalbuminaemia. All received skin traction before 173 (86.5%) underwent surgical fixation. Median time from admission to surgery was 19.0 days (IQR 12.3–25.0). Median hospital stay was 9.0 days (IQR 12.3–25.0). Mortality rates were 13% and 33.5% at 30 and 365 days, respectively. Over 1 year, African patients were more likely to die than Indian patients (40.9 versus 30%, HR 11.5 [95% CI 1.51, 2.57]; p = 0.012); delays to surgery predicted death (HR 1.02 [95% CI (1.00, 1.04)]; p = 0.022). In multivariate analyses, death at 1 year was most strongly predicted by an elevated serum creatinine (HR 2.43, 95% CI (1.02, 5.76), p = 0.044].

Conclusion

Hip fractures are associated with high MRs, in part explained by insufficient surgical capacity, highlighting the need for national efforts to improve hip fracture service provision.

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Acknowledgements

We are grateful to the patients who participated and hospital staff who helped with this study.

Funding

This study was funded by an unrestricted educational grant from Servier® and Competitive Research grant of the University of KwaZulu-Natal for Doctoral and Masters students, renewable for 2 years. CLG has received funding from the University of Bristol’s Global Challenges Research Fund allocation from Research England, and QR GCRF Funding.

Author information

Authors and Affiliations

  1. Division of Internal Medicine, School of Clinical Medicine, College of Health Science, University of KwaZulu-Natal, 719 Umbilo Road, Congella, Durban, KwaZulu-Natal, 4001, South Africa

    Farhanah Paruk

  2. Department of Statistics, Durban University of Technology, Durban, South Africa

    Glenda Matthews

  3. Musculoskeletal Research Unit, University of Bristol, Bristol, UK

    Celia L. Gregson

  4. Department of Geriatrics, Division of Internal Medicine, School of Clinical Medicine, College of Health Science, University of KwaZulu-Natal, Durban, South Africa

    Bilkish Cassim

Authors
  1. Farhanah Paruk
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  2. Glenda Matthews
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  4. Bilkish Cassim
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Contributions

FP: study concept and design, acquisition of patients and/or data, analysis and interpretation of data, and preparation of manuscript.

GM: analysis and interpretation of data, and preparation of manuscript.

BC: study concept and design, analysis and interpretation of data, and preparation of manuscript.

CLG: analysis and interpretation of data, and preparation of manuscript.

Corresponding author

Correspondence to Farhanah Paruk.

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Paruk F, Matthews G, Cassim B, Poster presentation World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. 26–29 March 2015. Milan, Italy, Predictors of mortality in hip fracture patients aged 60 years and over with minimal trauma hip fractures in the eThekwini municipality, Kwazulu-Natal, SA

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Paruk, F., Matthews, G., Gregson, C.L. et al. Hip fractures in South Africa: mortality outcomes over 12 months post-fracture. Arch Osteoporos 15, 76 (2020). https://doi.org/10.1007/s11657-020-00741-4

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