Variation in care for patients presenting with hip fracture in six high-income countries: A cross-sectional cohort study

Nitzan Burrack, Laura A. Hatfield, Pieter Bakx, Amitava Banerjee, Yu Chin Chen, Christina Fu, Carlos Godoy Junior, Michal Gordon, Renaud Heine, Nicole Huang, Dennis T. Ko, Lisa M. Lix, Victor Novack, Laura Pasea, Feng Qiu, Therese A. Stukel, Carin Uyl-de Groot, Bheeshma Ravi, Saeed Al-Azazi, Gabe WeinrebPeter Cram, Bruce E. Landon

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Hip fractures are costly and common in older adults, but there is limited understanding of how treatment patterns and outcomes might differ between countries. Methods: We performed a retrospective serial cross-sectional cohort study of adults aged ≥66 years hospitalized with hip fracture between 2011 and 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. We examined mortality, hip fracture treatment approaches (total hip arthroplasty [THA], hemiarthroplasty [HA], internal fixation [IF], and nonoperative), and health system performance measures, including hospital length of stay (LOS), 30-day readmission rates, and time-to-surgery. Results: The total number of hip fracture admissions between 2011 and 2018 ranged from 23,941 in Israel to 1,219,696 in the US. In 2018, 30-day mortality varied from 3% (16% at 1 year) in Taiwan to 10% (27%) in the Netherlands. With regards to processes of care, the proportion of hip fractures treated with HA (range 23%–45%) and THA (0.2%–10%) differed widely across countries. For example, in 2018, THA was used to treat approximately 9% of patients in England and Israel but less than 1% in Taiwan. Overall, IF was the most common surgery performed in all countries (40%–60% of patients). IF was used in approximately 60% of patients in the US and Israel, but only 40% in England. In 2018, rates of nonoperative management ranged from 5% of patients in Taiwan to nearly 10% in England. Mean hospital LOS in 2018 ranged from 6.4 days (US) to 18.7 days (England). The 30-day readmission rate in 2018 ranged from 8% (in Canada and the Netherlands) to nearly 18% in England. The mean days to surgery in 2018 ranged from 0.5 days (Israel) to 1.6 days (Canada). Conclusions: We observed substantial between-country variation in mortality, surgical approaches, and health system performance measures. These findings underscore the need for further research to inform evidence-based surgical approaches.

Original languageEnglish (US)
Pages (from-to)3780-3791
Number of pages12
JournalJournal of the American Geriatrics Society
Issue number12
StatePublished - Dec 2023


  • healthcare policy
  • hip fracture
  • international comparison
  • longevity
  • osteoporosis

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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