Hip fractures are increasing in incidence due to increasing life expectancy of the general population, although they are plateauing in the United Kingdom.1 Hip fractures often reflect an underlying diagnosis of osteoporosis.2,3 There is a focus upon improving hip fracture care because the outcomes in terms of 30 day and one year mortality have mean rates of 3.5–10% and 30% mortality at one year.4 Studies have shown older age, male gender and prefracture comorbidity are associated with increased mortality rates.5,6

The implementation of best practice tariffs (BPT) has led to an increased focus on the standards of care in the hip fracture population.7 The introduction of BPT has led to both clinicians and administrators working together in order to prioritize this health group. Hip fractures are an important focus for hospitals in terms of health economics.8 The economic cost has been reported at over £1 billion per budget year in the National Health Service (NHS) for hip fractures with fragility related falls costing over £2.3 billion per year.9 They can act as a surrogate marker for the health of a population and help benchmark the performance of a hospital or system against established best practice standards. A number of countries have established national audits which collect and publish hip fracture standards of care.10, 11, 12 Internationally there are similarities between the reported standards and outcomes.12 Best practice tariffs were introduced to encourage adherence to hip fracture standards (HFS). It is not known if the tariffs, the geriatric care or individual features of the HFS contribute to improving mortality in this cohort. It appears that when all best practice tariffs are met that there is a reduction in mortality.13 As mortality rates improves it is important to continue to explore which factors are responsible for driving improvements and whether it is a system of care approach that improves outcomes or whether there are individual factors that exert a major impact.

Contemporary geriatric care has advanced in recent years with establishment of a dedicated Ortho-geriatric sub speciality.14 Its importance has been highlighted by the inclusion of three HFS relating to its care, review by a geriatrician, bone health assessment and specialist falls assessment (HFS 4–6). The Irish Hip fracture database (IHFD) uses the same standards as the UK HFD. It is not known how well the individual HFS impact upon outcomes such as 30 day and one year mortality. In this paper we examine how adherence to hip fracture standards influences 30 day and 1 year mortality outcomes by exploring each standard as an independent variable and the aggregate benefit as increasing numbers of standards are met. The secondary outcomes are to assess the impact of the HFS linked to specialist geriatric care on mortality (HFS 4–6) and also to assess the impact of other patient factors on mortality.