• Lauren A Beaupre, Eugene K Wai, Donald R Hoover, Helaine Noveck, Darren M Roffey, Donald R Cook, Jay S Magaziner, and Jeffrey L Carson.
• Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
• Int J Qual Health Care. 2018 Mar 1; 30 (2): 97-103.

ObjectiveTo determine if adjusted mortality, walking ability or return home differed after hip fracture surgery between Canada and the USA.DesignSecondary analysis of the Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial data.SettingData were collected from 47 American and Canadian hospitals.ParticipantsOverall, 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.InterventionDemographics, 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 OutcomesMortality, inability to walk and return home.ResultsUS 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).ConclusionsAdjusted 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.

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