The Impact of Rurality on the Standard of Care for Hip Fracture Patients: An ANZHFR Study

BACKGROUND: Hip fracture care requires timely, multi-disciplinary management. This study examined whether rural hospital location was associated with adherence to the Australian Hip Fracture Clinical Care Standard (HFCCS). METHODS: Australian and New Zealand Hip Fracture Registry data from 2018 to 2023 were analysed for patients aged ≥ 50 years. Hospitals were classified using the Modified Monash Model as metropolitan (MM1-2) or rural (MM3-7). Patients transferred before surgery were excluded from the primary analysis and examined separately. Missing data were addressed using multiple imputation. Logistic regression was adjusted for age, sex and ASA classification. RESULTS: The primary analysis included 58 757 patients (50 727 metropolitan; 8030 rural). Metropolitan hospitals had higher adherence to cognitive assessment (72.8% vs. 68.1%), nerve block administration (94.0% vs. 91.2%), delirium assessment (76.2% vs. 70.1%), surgery within 48 h (80.3% vs. 78.7%), mobilisation within 24 h (92.9% vs. 90.9%) and secondary fracture prevention (81.3% vs. 69.8%) (all p < 0.05). Rural hospitals had lower adjusted odds of adherence for these indicators (ORs 0.54-0.90). Analgesia within 30 min was more frequent in rural hospitals (80.7% vs. 77.6%; adjusted OR 1.20, 95% CI 1.13-1.28). CONCLUSION: Rural hospital location was associated with lower adherence to several HFCCS indicators, particularly cognitive and delirium assessment, early mobilisation and secondary fracture prevention, while timely analgesia was more frequent in rural hospitals. Geographical variation in guideline-based hip fracture care persists in Australia and warrants further investigation.