Resources

Hip fracture is the fracture that requires most resources of all osteoporotic fractures. In the Western hemisphare, women after menopause have a calculated risk of 50 % of getting some form of osteoporosis-related fracture, and about 1 in 6 will get hip fracture (Cooper 1997, Lauritzen et al 1993). Initially all patients with hip fracture require surgery and hospitalization. The mortality rate is slightly increased (10-15%) of hip fracture patients in the first year after a hip fracture, compared with age-and gender-matched control population without hip fracture. Mortality is highest in patients who received institutional care before the fracture – three times higher than in patients coming from independent living (Holmberg et al 1986). Hip fractures account for more than half of all fracture-related direct healthcare costs (Johnell 1997). The annual number of hospital days for hip fractures have in comparison proved to be greater than for heart attack, breast cancer, chronic obstructive pulmonary disease, or diabetes mellitus among women older than 45 years of age (Kanis et al, 1997). Today’s Swedish figures with fewer hospital days may be slightly different, because a major part of the rehabilitation of the elderly patients is at rehabilitation sites within the primary care. Hip fracture treatment has improved and at the same time, the importance of a common optimized care programs has become increasingly clear (Thorngren et al 2002, Swedish National Board Guidelines 2003).

Hip fractures are the group of all types of surgical diseases that consume the most care throughout the continuum of care. A coordinated follow-up of hip fracture care in Sweden is therefore expected to lead to better treatment and effective cost utilization. This type of control of the quality of the various orthopaedic units in the country is of fundamental importance for health care. RIKSHÖFT collects different data such as information on housing, the need for institutional care, walking ability and the patients’ evaluation of pain. The patients are followed for four months after the fracture, which is the time period previous studies have shown to be most decisive and in which most of the gains of rationalization are to be achieved. Additional registration is made of patients that require reoperation within 10 years from the primary operation.