England has the highest mortality rate for hip fracture out of 11 OECD countries, according to new international study.

High mortality among hip fracture patients is occurring despite England performing well on other care quality measures such as over 82% of hip fracture patients in England receiving hip surgery within 48 hours of admission, second only to 85% of patients in Sweden. 

Yet, one year after their initial admission, 31% of English patients had died, compared with only 25% of Swedish patients and less than a quarter of patients in in Canada (23%), Australia (22%) and France (20%). 

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The International Collaborative on Costs, Outcomes and Needs in Care (ICCONIC) study, led by researchers at Harvard University and London School of Economics and co-funded by the Commonwealth Fund and the Health Foundation, used electronic medical records to compare the cost and quality of care between health care systems in 11 OECD countries, including the NHS in England. 

Looking at pre-pandemic data from 2014/15 to 2017/18, it focused on two groups of high-need older patients that represent priority areas for the NHS and other health systems. These were those hospitalised with a hip fracture and those hospitalised with heart failure who also have diabetes. 

Hip fracture patients spend too much time in hospital

Another key area where England stands out from other countries included in the analysis is the length of time that hip fracture patients spend in hospital. Patients in England spent an average of 21.7 days in hospital after their surgery – the highest of all 11 countries evaluated.  

The study suggests there is a significant opportunity to achieve higher quality care for patients, in part by learning from how other health systems deliver care and the investment it takes to do so. 

The findings add weight to national audits that have identified several areas for improvement in the care of hip fracture patients. More generally, the study provides further evidence that, while the NHS remains a relatively low-cost health care system that performs well in some areas, mortality rates for some patients are higher than in comparable countries – including in key areas such as cancer and cardiovascular disease.

The Health Foundation says that the results ultimately highlight major gaps in the available data in England and the need for investment to better understand what is happening to patient care across acute hospitals, rehabilitation services, support in the community and social care. 

It added that hospital is not the best place for a frail older patient to stay following surgery as it is not conducive to rehabilitation. By investing in post-hospital care, there may be scope to reduce the length of hospital stays for hip fracture patients and free up additional capacity to deal with the backlog of care. 

Dr Jennifer Dixon, Chief Executive of the Health Foundation, said:  "The findings of the ICCONIC study warrant urgent further investigation, particularly the finding of higher mortality among patients with hip fracture in the year after their admission for emergency treatment.  

"The study also highlights the lack of high-quality data that is available across the wider system of health and care which limits our understanding of what is happening on the ground, and the ability of clinical teams and NHS policymakers to act to improve care. However, there is now a clear opportunity with the introduction of new integrated care systems to make a step change in terms of linking up patient data and using the insights generated by this to reduce delays in discharge and improve quality of care and patient experience."

For more news and articles on hip fracture go to our musculoskeletal section