Epidemiology and Factors Associated with Clinical Outcomes of Fragility Hip Fractures in Kamphaeng Phet Province, Thailand

Abstract

Purpose: This study investigated the epidemiological characteristics, incidence, and outcome-related factors of fragility hip fractures in Kamphaeng Phet Province, examined care pathway time intervals, comparing office-hour and off-hour arrivals, and identified independent predictors of in-hospital mortality.

Methods: This retrospective cohort study analyzed data from the provincial health database between 2020 and 2023. Eligible participants were adults aged ≥50 years with low-energy hip fractures (ICD-10: S72.0, S72.1, S72.2). Beyond Multivariate logistic regression and survival analysis (Kaplan–Meier and Cox proportional hazards model) were employed to identify independent predictors of clinical outcomes.

Results: This study included 901 patients (mean age; 77.3 years, 66.0% women). The average incidence rate was 89.2 per 100,000 population annually. The mean time from injury to hospital arrival was 101.4 h. Multivariate logistic regression revealed that delayed surgery (>48 h) was a significant independent predictor of in-hospital mortality (adjusted odds ratio = 2.45, 95% confidence interval; 1.20–4.98, p = 0.012). Survival analysis confirmed that age ≥ 70 years (hazard ratio [HR] = 3.10, p = 0.004) and delayed surgery (HR = 2.25, p = 0.018) significantly increased the hazard of mortality.

Conclusions: Although in-hospital admission processes were efficient, delayed surgery significantly increases the risk of in-hospital mortality. These findings emphasize the critical importance of the 48-h surgical window. Healthcare policies should focus on reducing pre-hospital delays and surgical waiting times to improve survival outcomes in patients with fragility hip fracture.