AB073. SOH23ABS_133. Service-level factors associated with total arthroplasty rate and time to arthroplasty surgery after hip fracture in Ireland: analysis of the national Irish Hip Fracture Database 2017–2020

Background: Current guidelines suggest that total hip arthroplasties (THAs) should be performed for intracapsular hip fractures in patients with high pre-fracture function and low co-morbidity. Despite increasing rates of THA internationally, Ireland’s rate remains low. This study aimed to explore hospital-level variation, factors, and outcomes associated with THA provision.

Methods: All cases of intracapsular fractures from the national Irish Hip Fracture Database (IHFD) between the years 2017 and 2020 were identified and guideline-based eligibility for THA defined. Multi-level logistic regression at patient and hospital-level was conducted to explore factors associated with the provision of THAs and the association of THA provision with six outcomes: time to surgery, day one mobilisation by (I) a physiotherapist and (II) any profession, 7- and 14-day mortality and discharge destination.

Results: In the IHFD there were a total of 7,597 intracapsular fractures between 2017 and 2020 [69% female; mean age, 79.9 years (standard deviation, 8.7)]. A total of 1,861 (24.5%) were defined as eligible for THA based on low co-morbidity and high pre-fracture mobility scores. The proportion who received THAs among all patients with intracapsular fractures and those deemed “eligible” for THA was 6.8% (n=516) and 17.6% (n=328), respectively. There was variation in THA rate across hospitals in the IHFD, ranging in the “eligible” group from 6.8% to 31.6%.

Conclusions: THA provision appears largely in line with current guidelines but there is significant hospital-level variation across Ireland.

Keywords: Total hip replacement; arthroplasty; early mobilisation; hip fracture; femoral fracture