Impact of Standardized Care Protocols on Hip Fracture Outcomes: Mitigating Socioeconomic and Racial Disparities in a Universal Healthcare System: A Retrospective Cohort Study.

Abstract

Background: Socioeconomic deprivation and race and ethnic background are established predictors of poorer health outcomes and mortality after a hip fracture. The extent to which standardized, evidence-based treatment protocols can address these disparities remains unclear.

Methods: We analyzed data from 637 patients treated for hip fractures at a level 1 trauma center over 5 years. All patients received care according to a standardized protocol aligned with national best practice standards.

Results: Four hundred eleven (65%) patients underwent surgery within 36 hours of diagnosis. The mortality was 34.7% over 5 years. Factors significantly associated with mortality included delayed surgery (p < 0.05), American Society of Anesthesiologists grade (p = 0.003), and frailty (p = 0.001). Ethnicity (p = 0.381) and socioeconomic class (p = 0.678) were not significant predictors of mortality. There was no difference in the pattern of hip fractures, the treatment given, the timeliness of surgery, or patient mortality when patients of different ethnic background and socioeconomic status were compared.

Conclusions: Standardized, evidence-based protocols and treatment pathways within healthcare systems have the potential to enhance clinical outcomes and minimize the influence of socioeconomic and racial disparities on postoperative mortality. These findings highlight the crucial role of equitable access to care and the implementation of structured treatment protocols and standards in addressing health inequities.

Level of evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.