Gender Influences Patient Characteristics, Fracture Pattern, Achievement of Clinical Care Targets and Postoperative Mortality Risk Following a Hip Fracture: A Retrospective Cohort Study.

AIMS: This study assesses whether patient gender is associated with differences in demographics and fracture characteristics, clinical care, mortality risk and length of acute hospital stay following a hip fracture. METHODS: A retrospective cohort study was undertaken of all patients aged ≥ 50 years admitted with a hip fracture from the emergency department (ED) at a single centre during a 42-month period. Patient demographics, perioperative variables and mortality were collected as part of the Scottish Hip Fracture Audit (SHFA). RESULTS: 3613 patients (mean age 80.9; 71% female) were included. The mean follow-up was 607 (range 240-1542) days. 1600 deaths were identified (44.3% mortality). Male patients were younger (p < 0.001), less likely to reside in a care home (p < 0.001), and more likely to sustain an extracapsular fracture (p = 0.048). Male patients spent longer in the ED (p = 0.030), were less likely to have the ED 'Big 6' completed (p = 0.017) and had a longer time to theatre (p = 0.001). Male gender was independently associated with an increased mortality risk (hazard ratio 1.56, 95% CI 1.39 to 1.74, p < 0.001, Cox regression) relative to females. Gender did not influence the length of acute hospital stay (mean difference 0.4 days, 95% CI 0.33 to 1.12, p = 0.290, regression analysis). CONCLUSION: Despite adjusting for several observed differences, male gender is associated with a greater mortality risk. These differences should be explored further to improve clinical care and outcomes.