Dr Antony Johansen's presentation from Osteoporosis 2016: Explaining the risk of hip fracture – using data from the National Hip Fracture Database to inform surgeons, anaesthetists and their patients. Find out more at: https://nos.org.uk/conference

1. Discussing risk with patients
– using NHFD data to inform discussions
Antony Johansen, Carmen Tsang, Chris Boulton
Viv Burgon, David Cromwell and Rob Wakeman
National Hip Fracture Database

2. www.nhfd.co.ukwww.nhfd.co.uk

4. www.nhfd.co.uk - accessed 6th
November 2016
All hospitals – unadjusted 30 day mortality

5. Case study

6. “Can I make her fitter?
“Can she lie flat?”
“Why isn’t she first on the list?”
“Can I make her any fitter?”
“She may die on
the table”

7. National Confidential Enquiry
into Peri-operative Deaths
www.ncepod.org.uk - 2001

8. Reasons for postponement
of hip fracture surgery

9. Methods
We used NHFD data to examine inpatient mortality for 64,864
patients who presented with hip fracture in 2015
We excluded patients where ASA grade, date of surgery or date
of discharge were missing
Stratified by American Society of Anaesthesiologists (ASA) grade

10. ASA grading in
different units
Over half of
patients were
graded ASA 3
NHFD report 2016

11. Results
6.6% of the remaining 59,369 patients died in hospital
A third (34.7%) of inpatient deaths were in ASA 4 patients

16. Conclusions
High “relative risk” might discourage surgeons and
anaesthetists from offering an operation, and deter
patients and their loved ones from agreeing to it
Over 98% of ASA 4 patients survived the day of surgery,
and the day after it, and only 16.5% died as inpatients
Discussion should set this level of risk against the 48.6%
mortality seen in those who received non-operative care

17. antony.johansen@wales.nhs.uk
www.nhfd.co.uk