# Distinct Characteristics of Patients With Fragility Hip Fracture in Greece: Evidence From the Greek National Fragility Hip Fracture Registry Utilizing the Minimum Common Data Set

## TL;DR

This study uses Greece's first national hip fracture registry to show that Greek patients have unique characteristics and healthcare challenges, such as delayed surgeries and high mortality rates.

## Contribution

The study presents the first national fragility hip fracture registry in Greece, offering insights into local healthcare system performance and patient outcomes.

## Key findings

- Most patients were elderly females with peri-trochanteric fractures and high pre-injury independence.
- Only 31% of patients received surgery within 48 hours, leading to longer hospital stays and higher mortality.
- Greek 30-day mortality rates are comparable to other European countries despite healthcare system delays.

## Abstract

Background

Over the past two decades, fragility hip fracture registries have been implemented in various countries worldwide. These registries have played a key role in documenting the state of individual health care systems, highlighting the specific challenges they face, and showcasing the unique characteristics of each population. The aim of the present study is to highlight the distinct characteristics of the Greek fragility hip fracture patients, utilizing the data from the first two years of the first national fragility hip fracture registry in Greece.

Materials and methods

Nine orthopaedic departments from eight hospitals across the country participated in this prospective multicenter study. All cases of hip fragility fractures between September 2022 and December 2024 were prospectively recorded in a centralized database. Data collection was based on the 21-point Minimum Common Data Set recommended by the Global Fragility Fracture Network, with the addition of 30-day mortality data. A complete case analysis was performed, excluding records with missing data. Multivariable regression and neural network models were developed to assess predictors of 30-day mortality and length of stay. Model discrimination was assessed using the area under the receiver operating characteristic curve (AUC).

Results

A total of 2139 patients (aged 82.4±8.4 years) with a fragility hip fracture admitted in the involved orthopaedic departments were included in the study. The majority of the patients were female (70,6%) and had sustained a peri-trochanteric fracture (58.2%). A significant proportion of the patients were staying at their own home before the injury, and 65% of the patients were fully independent, mobilising freely or with one stick outdoors. Most of the patients were treated surgically (94.4%), but the surgical intervention was performed within the first 48 hours in only 31% of the cases. The mean in-hospital length of stay was 10.68 ±8.1 days, with 60% of the patients returning to their own home after discharge. The in-hospital mortality was 4%, while the 30-day mortality reached 10.9%.

Multivariate and neural network analysis revealed that increased age and male gender negatively affect the 30-day mortality of these patients. Their pre-injury residence as well as the exit destination were also significant predicting factors for the 30-day mortality. The prompt surgical intervention (within 48 hours of admission) and the pre-injury mobility level influence the length of in-hospital stay of these patients (p<0.001).

Conclusions

Greece’s first national hip fracture registry highlights key healthcare system gaps, particularly the low rate of timely surgeries for fragility hip fractures, which is linked with prolonged hospital stay. Despite this, the 30-day mortality rate aligns with other European countries. High pre-injury independence and the number of patients discharged home positively influence their outcomes.