Early results of starting a fracture liaison service for fragility hip fractures in a regional South African hospital.

BACKGROUND

Fragility hip fracture is a rising pandemic, with the burden currently shifting to developing countries. A fracture liaison service (FLS) was implemented in September 2021 in a regional South African (SA) hospital.

OBJECTIVE

To describe two groups of patients with surgically treated fragility hip fractures - those before and after implementation of the FLS - in terms of early mortality, refracture and readmission rates.

METHODS

Patients aged >50 years who sustained hip fractures between January 2020 and June 2022 were considered; those with high-energy injuries, pathological and periprosthetic fractures were excluded. Associations between treatment group and mortality, readmission and refracture rates within the first year after surgery were investigated. Subgroup analyses were also conducted for specific risk factors.

RESULTS

A total of 299 patients (mean (standard deviation) age of 74.5 (11.0) years, 68.2% female) were included, of whom 32.8% (n=98) received bisphosphonates. The overall 30-day, 90-day and 1-year mortality rates were 9.4% (n=28), 17.4% (n=52) and 29.8% (n=89), respectively, while 24.1% (n=72) of patients had unplanned readmissions to hospital, and 2.7% (n=8) refractured within the first year after surgery. No statistical difference in 30-day, 90-day or 1-year mortality rate, refracture incidence or readmission incidence was observed between patient groups. Time to surgery was shorter after the implementation of the FLS (median (interquartile range (IQR)) 30.8 (22.3 - 48.9) hours v. before (median (IQR) 42.5 (23.1 - 70.8) hours, p=0.039).

CONCLUSION

An FLS was successfully implemented in a regional SA hospital. Early mortality, refractures and readmission rates were low or comparable with the existing literature, and not affected by treatment within the FLS nor by bisphosphonate initiation. Treatment within the FLS, however, resulted in a decrease in time to surgery.