Reoperation in the year following a hip fracture

Aims: The aim of this study was to characterize the risk of reoperation in the year after surgery for a hip fracture in England. Methods: Patients aged ≥ 60 years who presented with a hip fracture at 159 English hospitals during a three-year period between April 2016 and March 2019, were identified and linked with anonymized data from routinely collected data sources (Hospital Episodes Statistics, Civil Death Registration, National Hip Fracture Database), and followed up to 365 days. The Office of Population Censuses and Surveys (OPCS) Classification of Interventions and Procedures codes identified all patients with a hip fracture who had a reoperation, and descriptive statistics were calculated. Results: A total of 164,691 patients presented with a hip fracture during the study period. Their mean age was 83 years (SD 8.6), and 70.8% were female. During the following 365 days, 4.6% had at least one reoperation. This varied from 2.3% to 9.4% between different hospitals. Reoperation was most common for patients with a sub-trochanteric fracture fixed with a cephalomedullary nail, at 7.2%. The most common indication for reoperation within 30 days of the initial surgery was infection, and after 30 days it was periprosthetic fracture. Reoperation was less common among older patients. Those aged ≥ 90 years had a risk of reoperation of 3.7% compared with 6.2% for patients aged between 60 and 69 years. A total of 27.3% died within 365 days of the initial presentation, but the rate of mortality was similar for those who did and those who did not have a reoperation (28.0% vs 27.3%). Conclusion: Reoperation after surgery for a fracture of the hip is common. These novel data can enable informed shared decision-making for this high-risk group of patients.