Predictors of Mortality in Patients with Femoral Neck Fracture

Purpose To identify patient and procedural factors associated with in-hospital mortality following a femoral neck fracture.Methods Records of 598 female and 259 male consecutive patients aged 29 to 108 (median, 82) years admitted between 2010 and 2014 with femoral neck fracture were retrospectively reviewed to determine patient and procedural factors associated with in-hospital mortality.Results 73% of patients were operated on within 48 hours of admission. The in-hospital mortality was 7.5%, with 2.1% occurring preoperatively and 5.4% postoperatively. Factors associated with increased preoperative mortality included being non-ambulant prior to admission (p=0.015), residence in interim care (p=0.001) or low-level care (p=0.049), having synchronous fractures (p=0.001), and having a concurrent acute medical condition (p<0.001). Patient factors associated with increased in-hospital mortality included male gender (p=0.041), age >80 years (p=0.001), non-ambulatory status (p=0.015), residence in high-level care (p=0.031) or low-level care (p=0.018), American Society of Anesthesiologists grade 4 or 5 (p<0.001), weekend admission (p<0.001), and having an acute medical condition on admission (p<0.001). Procedural factors associated with increased in-hospital mortality included >96-hour delay to surgery from admission (p<0.001), surgery over the weekend (p=0.005), and surgical interventions other than total hip arthroplasty (p<0.05).Conclusion Identification of patient and procedural factors can guide changes in best practice to decrease mortality following a femoral neck fracture.