@article{f573f4ca653b41248566f7fa4910e37e,
title = "Trends in Operative and Nonoperative Hip Fracture Management 1990–2014: A Longitudinal Analysis of Manitoba Administrative Data",
abstract = "Objectives: To evaluate longitudinal trends in the use of total hip arthroplasty (THA), hemiarthroplasty (HA), internal fixation (IF), and nonoperative management and to identify individual-level factors associated with nonoperative treatment of hip fracture (HF). Design: Longitudinal analysis of administrative data. Setting: Manitoba, Canada. Participants: All adults who experienced nontraumatic hip fractures between 1990 and 2014 (N = 19,626; mean age 80.6, 72.3% female). Measurements: Billing codes were used to identify surgical treatment, and trends in treatment over time were examined. Regression models were developed to identify individual factors associated with receiving nonoperative management. Results: Use of THA increased from 0.6% for all HFs in 1990–94 to 5.3% in 2010–14, use of HA increased from 19.3% to 29.7%, and use of IF declined from 71.8% to 59.9% (P <.001 for all); increase in THA and HA were largest in individuals with femoral neck fracture. Nonoperative management declined from 8.3% in 1990–94 to 5.1% in 2010–14 (P <.001). Factors associated with nonoperative management included aged 90 and older, male sex, residing in a care facility before fracture, and rural residence. Conclusion: HF is increasingly treated with THA and HA, whereas rates of nonoperative management and IF are declining. Future efforts should focus on ensuring that all individuals are optimally triaged to the best procedure for them, with nonoperative management considered for individuals with extremely poor prefracture health.",
keywords = "epidemiology, hip fracture, prognosis",
author = "Peter Cram and Lin Yan and Eric Bohm and Paul Kuzyk and Lix, {Lisa M.} and Morin, {Suzanne N.} and Majumdar, {Sumit R.} and Leslie, {William D.}",
note = "Funding Information: Conflict of Interest: None of the authors have any conflicts of interest. The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository under project 2008/2009–16. The results and conclusions are those of the authors, and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred. Data used in this study are from the Population Health Research Data Repository housed at the Manitoba Centre for Health Policy, University of Manitoba, and were derived from data provided by Manitoba Health. SRM holds the Endowed Chair in Patient Health Management (Faculties of Medicine and Dentistry and Pharmacy and Pharmaceutical Sciences, University of Alberta). LML is supported by a Manitoba Research Chair. SNM is a clinician-researcher scholar of Fonds de Recherche du Qu{\'e}bec en Sant{\'e}. Dr. Cram is supported by a K24 AR062133 award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health (NIH). Author Contributions: PC, WL: obtaining funding: PC, LL, EB, WL: writing protocol. LY, LL: coding and analysis. PC, LY, LL, SM, EB, WL: statistical guidance. PC, LY, LL, SM, SM, EB, WL: interpretation of results. PC, PK, LY, LL, SM, SM, EB, WL: drafting and revising manuscript. Sponsor's Role: Neither NIH nor any other external agencies had any role in the design or conduct of the study; collection, management, analysis, or interpretation of data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2016, Copyright the Authors Journal compilation {\textcopyright} 2016, The American Geriatrics Society",
year = "2017",
month = jan,
day = "1",
doi = "10.1111/jgs.14538",
language = "English (US)",
volume = "65",
pages = "27--34",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
number = "1",
}