Epidemiology and trends of hip fracture in centenarians: changes in clinical profile and in-hospital outcomes from a nationwide register study in Spain across 2004-2020

Abstract

[Abstract]

Background: Proximal hip fractures (PHFs) increased worldwide due to population ageing and represent the third cause of admission in Spanish centenarians. Recognizing trends in their evolution could improve their healthcare.

Aim: To describe changes in trends in clinical characteristics, surgical decisions and in-hospital outcomes in PHF among centenarians in Spain, 2004 and 2020.

Methods: This retrospective observational study included centenarians hospitalized with a principal diagnosis of PHF using data from the Hospital Discharge Records-Minimum Basic Data Set of the Spanish National Health System. Trends were analyzed using joinpoint regression analysis and descriptive and univariate statistics.

Results: 4,261 PHF admissions among centenarians were recorded. The number of PHF admissions increased from 147 in 2004 to 339 in 2020 (Average Percentage Change (APC)= 3.8%), with a higher increase in women. However, there was a reduction in the incidence of admissions in the last five years. Despite a significant increase in multimorbidity (from 44.4 to 64.1%) and in-hospital complications, there was a decreased in surgical delay (with more surgeries performed within 48 h: from 27.6 to 43.3%) and length of hospital stay (from 12.2 ± 8.6 to 9.7 ± 8.0 days), with a notable shift towards arthroplasty (from 28.7 to 52.7%), and stable mortality rates (APC=-1.5).

Conclusion: This study indicates an increased complexity in patient profiles, with higher rates of multimorbidity and complications, but improvements in surgical care have led to reduced surgical delays and shorter hospital stays. Future studies are necessary to understand the factors associated with these trends and to design specific strategies in this vulnerable population.