Issue: May 2015
March 12, 2015
2 min read

Best-practice pathway for hip fractures reduced mortality rates in elderly patients

Issue: May 2015
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Use of a best-practice pathway for the treatment for hip fractures in elderly U.K. patients was linked with a 15% reduction in the national 30-day postoperative mortality rate, according to results presented at a recent meeting.

“We set out nearly 10 years ago to see if we could change the system by attacking it in three ways: looking at developing care standards for people to work to; having a national audit system to see whether those care standards were met; and then also using money to change the system,” Christopher G. Moran, MD, FRCS(Ed), said in his presentation.

The British Orthopaedic Association and British Geriatric Society developed professional care standards and from these a best-practice pathway for 186 hip fracture units in England that included 10 key standards: admissions protocol; joint orthopedic and geriatric care; surgery within 36 hours; geriatric review within 72 hours; multidisciplinary rehabilitation; falls and osteoporosis assessments; pre- and postoperative cognitive assessment; and data submission to the National Hip Fracture Database. Hospitals received financial incentives if patients undergoing treatment for hip fracture received all 10 parts of the pathway.

Displaced subcapital hip fracture treated with a cemented hemiarthroplasty.

Displaced subcapital hip fracture treated with a cemented hemiarthroplasty.

Image: Moran CG

The study included 215,000 patients with information entered in the National Hip Fracture Database. Patients had a mean age of 80 years and 71% were women. Within the first year of the best practice pathway (2010), 27% of patients received the complete pathway. Since then, the number of patients receiving the entire pathway increased each quarter, Moran said. Results showed by April 2012 to 2013 54.5% of patients received all 10 standards, while a further 25.8% received nine of the pathway measures. Moran and his colleagues found the national 30-day mortality following hip fracture has fallen from 9.2% in 2008 to 8.2% in 2013.

During his presentation, Moran noted differences between the health care system in England and those in other countries. “Acute care and rehab happens in the same hospitals so length of stay in England is a lot longer than the length of stay in the United States, but that does not mean to say the length of rehabilitation is longer,” he said. “We have had a significant reduction in the length of hospital stay since 2009.” – by Casey Tingle


Moran CG, et al. Abstract #58. Presented at: Orthopedic Trauma Association Annual Meeting; Oct. 15-18, 2014; Tampa, Fla.

For more information:

Christopher G. Moran, MD, FRCS(Ed), can be reached at Nottingham University Hospital, Derby Rd. Nottingham NG7 2UH, United Kingdom; email:

Disclosure: Moran was a mini symposia moderator for Smith & Nephew; is on the speakers bureau or received paid presentations from DePuy-Synthes; is on the International Editorial Board for Injury; and is a board member for the British Orthopaedic Association.