Aim This study aimed to identify factors associated with non-operative management (NOM) of hip fractures in Australia and New Zealand, comparing health outcomes and mortality with operative management. It also explored survival factors in palliative patients.
Methods A retrospective cohort study of patients aged 50 and older with hip fractures managed at participating Australian and New Zealand Hip Fracture Registry hospitals between 01/01/2021 and 31/12/2022 was performed.
Patients were categorised into four groups; operative, surgery not clinically indicated, palliative, and other. Patient characteristics, length of stay (LOS), discharge destination and mortality were compared.
A sub-analysis of the palliative group identified factors linked to survival by comparing patients who survived >30 days to those who died £30 days. LOS and discharge destination were also compared.
Results Among 31,423 patients, 30,734 (97.8%) received operative management, and 689 (2.2%) received NOM (438 palliative, 127 surgery not clinically indicated, and 124 other).
Palliative patients were older, more dependent on walking aids, institutionalized, frailer, and had higher dementia rates than the other groups. Men and those presenting to a Tasmanian hospital were more likely to receive palliative care.
The 30-day mortality rate was highest in the palliated group (87.2%) and lowest in the operative group (7.3%).
Increasing age was the only factor identified which correlated with earlier mortality in those palliated.
Conclusions Understanding the characteristics and outcomes of NOM can help determine which hip fracture patients may benefit from this approach. This study is the first registry study to report on NOM categorised by reasons.