Burden of pelvis fracture: a population-based study of incidence, hospitalisation and mortality.

Abstract

The objective of this study was to describe the incidence and consequences of pelvic fractures in a community cohort. The incidence of pelvic fractures increases with age with a protective effect of higher body mass index. Almost 60% of those with a pelvic fracture required an inpatient stay, with a median of 9 days. There was a higher 3-year mortality in those admitted (17%) vs. those not admitted (6.3%). Given the substantial health burden, further work is required to identify the optimal post-fracture therapeutic strategy to improve outcomes. The burden of pelvis fractures is projected to increase, but there is a paucity of community-based studies describing rates, mortality and future fracture risk. We therefore estimated the age, gender and BMI-specific incidence of pelvis fracture in Catalonia (North-East Spain), and assessed hospital stay and mortality following fracture. The SIDIAP(Q) database contains validated clinical information from computerised medical records of a representative sample of 30% of the population of Catalonia. We conducted a retrospective cohort study including all subjects aged ≥ 40 in SIDIAP(Q) and linked to the regional Hospital Admissions Database from 2007 to 2009. Pelvis fractures were ascertained using ICD-10 codes. Incidence and mortality rates were calculated. A total of 1,118,173 patients (582,820 women) were observed for 3 years and 1,356 had a pelvic fracture. The rate for pelvic fracture was 4.35/10,000 person-years (pyar) [95% CI 4.13-4.59] (men-2.73 [2.48-3.01]; women-5.82 [5.46-6.20]). This increased with age, peaking in those over 90 years: 29.41 [25.74-33.59]. Higher BMI was protective (HR 0.75 per SD BMI; [0.69-0.82]). Moreover, 59.1% of fractured patients were hospitalised with a median (IQR) stay of 9 (5-16) days, and after the 3-year follow-up 13.9% died (mortality rate 10.7/100 pyar [9.3-12.3]) with higher rates in those hospitalised (17.0%). Pelvic fractures are associated with high rates of hospitalisation and mortality. Given this, further work is required to identify the optimal post-fracture therapeutic strategy to improve outcomes in this elderly patient group.