A comparison of outcomes between Canada and the United States in patients recovering from hip fracture repair: secondary analysis of the FOCUS trial

Int J Qual Health Care. 2018 Mar 1;30(2):97-103. doi: 10.1093/intqhc/mzx199.


Objective: To determine if adjusted mortality, walking ability or return home differed after hip fracture surgery between Canada and the USA.

Design: Secondary analysis of the Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial data.

Setting: Data were collected from 47 American and Canadian hospitals.

Participants: Overall, 2016 subjects with a hip fracture (USA = 1222 (60.6%); Canada = 794 (39.4%)) were randomized to a liberal or restrictive transfusion strategy. Subjects were 50 years and older, with cardiovascular disease and/or risk factors and hemoglobin <100 g/L within 3 days post-surgery. The average age was 82 years and 1527(76%) subjects were females.

Intervention: Demographics, health status and health services data were collected up to 60 days post-surgery and mortality to a median of 3 years post-surgery.

Main outcomes: Mortality, inability to walk and return home.

Results: US subjects had higher adjusted mortality than Canadians at 30 days (odds ratio = 1.78; 95% confidence interval: 1.09-2.90), 60 days (1.53; 1.02-2.29) and up to 3 years (hazard ratio = 1.25; 1.07-1.45). There were no differences in adjusted outcomes for walking ability or return home at 30 or 60 days post-surgery. Median hospital length of stay was longer (P < 0.0001) in Canada (9 days; interquartile range: 5-18 days) than the US (3 days; 2-5 days). US subjects (52.9%) were more likely than Canadians (16.8%) to be discharged to nursing homes for rehabilitation (P < 0.001).

Conclusions: Adjusted survival favored Canadians post hip fracture while walking ability and return home were not different between countries. The reason(s) for mortality differences warrant further investigation.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Transfusion / statistics & numerical data
  • Canada / epidemiology
  • Female
  • Hip Fractures / mortality*
  • Hip Fractures / rehabilitation
  • Hip Fractures / surgery*
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Nursing Homes / statistics & numerical data
  • Postoperative Care
  • Recovery of Function*
  • Risk Factors
  • United States / epidemiology
  • Walking*