Aims: Prevalence of non-operative treatment for older patients with hip fracture in Thailand remains high. This study aimed to identify factors associated with the decision for non-operative treatments and the mortality in older patients with hip fracture.
Methods: A retrospective cohort study of older patients aged more than 60 years with hip fracture in Thailand using data from the national database and primary data collected from included 19 hospitals was conducted. Factors associated with decision for non-operative management were considered using logistic regression models. For mortality, cox regression models were utilized.
Results: Among 6202 subjects, the non-operative rate was 21.5%. In the multivariate analysis, factors associated with non-operative treatment were older age (> 80 years old), adjusted OR (aOR) of 2.60 (p<0.001), having cerebrovascular disease ( aOR 2.10, p<0.001), renal disease (aOR 1.73, p<0.001). Regarding mortality, age > 80 ( aOR 2.29, p<0.001), non-operative treatment(aOR 2.30, p<0.001), several co-morbid diseases and medical complications were associated with increased mortality. Interestingly, the process of care which is associated with reduced mortality was screening for delirium with OR 0.77, p<0.001).
Conclusions: Nonoperative treatment for hip fracture patients associated with increased mortality. Providing the high rate of nonoperative management in Thailand, strategies and policies to enhance the uptake of surgical rate should be implemented.