1	The Norwegian Hip Fracture Register Jonas Fevang MD PhD, Jan-Erik Gjertsen MD, Stein Atle Lie, Tarjei Vinje MD , Leif Ivar Havelin MD PhD,, Lars Engesæter MD PhD Ove Furnes MD PhD
2	Definition of hip fracture Fracture of the proximal femur Femoral neck fractures Intertrochanteric fractures Subtrochanteric fractures
3	Background Approximately 9000 patients are operated in Norway every year due to hip fracture. Hip fracture is a diagnosis associated with high mortality and morbidity. Large resources are used in the treatment of these patients. 55 hospitals treat hip fractures in Norway
4	Why a register of hip fractures? To evaluate the treatment of proximal femoral fractures in Norway using the following outcomes Complications Revisions Death Pain Patient satisfaction Quality of life
5	What can be studied? Using the data that we collect we would like to find out how these outcome variables are influenced by Co morbidity (ASA) Age Dementia Preoperative delay Diagnosis Operation method/implants Hospitals Infection prophylaxis Thrombosis prophylaxis
6	What can be studied? Examples: Is there a higher risk of death in patients with dislocated neck fracture treated with prosthesis compared with those treated with screws? Is there an increasing risk of death with increasing preoperative delay? Is there a difference in life-quality, patient satisfaction and pain in the different treatment groups?
7	What can be studied? Epidemiology A more accurate incidence of Fracture type Treatment Complications Revisions Mortality Changes over time
8	The Norwegian Hip Fracture Register Founded by the Norwegian Orthopedic Association Operated by The National Arthroplasty Register Certified by the Norwegian Data Inspectorate Initiated January 1^st 2005
9	Staff and Costs Costs: 250 000 $ per year Staff Working with the administration of the register: Project coordinator 100 % Secretary 50% Secretary 35% IT consultant 30% Medical staff supervisor 50% 2 resident surgeons 4 consultant surgeons ( connected to the NAR)
10	Collection of data The surgeon fills out a form after the operation This takes about 3-5 minutes One hospital has an electronic registration form There is one contact person (surgeon) at every hospital This person is responsible for sending the forms to the register every month The patient fills out a form 4 and 12 months after the primary operation
11	Patient consent form Every hospital is responsible for collecting signed consent forms from all patients The form is kept in the patient’s medical record
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14	The Questionnaire to the patient Measurement of Life quality -EuroQol-5D Patient Satisfaction (Visual Analogue Scale) Pain (Visual Analogue Scale) Charnley score
15	Quality of life -EuroQol-5D Standardized instrument for use as a measure of health outcome Applicable to a wide range of health conditions and treatments It is easy, taking only a few minutes to complete
16	EuroQol-5D Comprises 5 dimensions of health mobility self-care usual activities pain/discomfort anxiety/depression Each dimension comprises 3 levels no problems some/moderate problems extreme problems
17	EuroQol-5D The values defined by the questions are converted into a single index value (0-100) 0 is the worst imaginable health status 100 is the best imaginable health status
18	Charnley Score
19	Status after one year (2005) 55 of 55 hospitals are reporting to the register approximately 50 % of the patients have answered the follow-up questionnaire 5668 primary operations were reported 607 revision procedures 17% of the patients are dead
20	Is the risk of death higher in patients with dislocated neck fractures treated with prosthesis compared with those treated with screws? 2045 patients with medial femoral neck fractures Garden 3-4 1071 were treated with internal fixation (2 screws or pins) 974 were treated with bipolar hemiprosthesis
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27	Is there a difference in life-quality, patient satisfaction and pain in the different treatment groups? 495 patients operated for femoral neck fracture (Garden 3-4) answered the questionnaire four months after the operation. Two treatment groups Internal fixation (2 screws/pins): 273 patients Bipolar hemiprosthesis :222 patients
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33	Conclusion So far the register seems to function well Reporting is easy for the surgeon We have been working a lot in the orthopedic milieu Advantage of an already well-known prosthesis register In one year we will know if the reporting is good enough to study Revisions Epidemiology
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35	EuroQol-5D EQ-5D was initially developed simultaneously in Dutch, English, Finnish, Norwegian and Swedish. It is now widely used in many countries around the world and has been translated into most major languages with the EQ-5D Group closely monitoring the process.
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