The ICCONIC study published recently suggested that mortality following hip fracture was higher than in any of the ten other countries they examined. However, this study was based on a sample of just 7% of patients in England and does not accurately reflect the national situation. In contrast, the National Hip Fracture Database (NHFD), based at the RCP, uses data collected by the clinical staff looking after over 92% of all people with hip fracture; about over 60,000 people every year.
Over the last 15 years the NHFD has presided over dramatic improvements in hip fracture care, and has recorded 30 day mortality falling from 8.0% to 7.3% between 2014 and 2017; both figures being substantially better than the 9.8% found in the much smaller studied in the ICCONIC study. Continuing improvement since then means that mortality in England was just 6.6% prior to the COVID-19 pandemic in 2020; a figure that is actually better than the average figure of 7.1% reported across all the countries of the ICCONIC study.
The National Hip Fracture Database would like to caution against the prominence given to death rates as a measure of the outcome of hip fracture care in this very frail population. Previous work has shown that older people are more concerned to avoid dependency and care home placement following a hip fracture, so the NHFD focuses on successful return home as a marker of performance and care quality. We are pleased to see that the ICCONIC study highlighted England as having the lowest 30 day readmission rate, which is also good news for patient experience.