Abstract
Background
Hip fractures are a common fragility fracture in older people; more than 4,000 patients with a hip fracture in Wales were submitted to the National Hip Fracture Database in 2024. Survival rates have improved in recent years, however while women are twice as likely to sustain a hip fracture than men, the risk of dying is greater for men who sustain a hip fracture.
Methods
We conducted a retrospective comparison of the demographics, care received and outcomes across sex in patients with hip fracture in Cardiff and Vale University Health Board in 2024. This included pre-existing morbidity, type of fracture, post-operative delirium, discharge destination and mortality.
Results
Across the 558 patients recorded in 2024, women with hip fracture were less mobile before fracture (36% women independently mobile cf. 39% men) and less likely to have been admitted from their own home (83% cf. 87%), while men had greater co-morbidity with higher ASA grades (78% women ASA >2 cf. 85% men) and greater incidences of malnutrition (33% cf. 45%) and malignancy (1% cf. 3%). Men and women received comparable care and had similar rates of post-operative delirium, however men had longer lengths of admission (8 days cf. 10 days) and a higher 30-day mortality (4% cf. 9%).
Conclusion
The difference in 30-day mortality across sex in our cohort was comparable to previous national data, twice as high in men as women. While men in this cohort had greater morbidity before their fracture, this difference was less marked than expected. Further study is needed to explore the nature of co-morbidities and inform strategies to mitigate this disparity in future.