title: [The influence of timing of surgery on mortality and early complications in femoral neck fractures, by surgical procedure: an analysis of 22,566 cases from the German External Quality Assurance Program].
abstract: BACKGROUND
  The current S2 guideline recommends treatment of a femoral neck fracture within the first 24 h; this becomes evident by the significant rise in general and early surgical complications, when the surgical treatment was delayed for more than 48 h. The influence of different surgical procedures was investigated.                                PATIENTS UND METHODS:                  A total of 22,566 records from the external Quality Assurance Program in North Rhine-Westphalia for treatment of femoral neck fractures in 2004/2005 (BQS specification 7.0 and 8.0) were risk-adjusted and evaluated.
  
  
  RESULTS
  Surgery was performed within 48 h in 83.9% of the patients. A significant rise in general and early surgical complications was registered when the surgical treatment was delayed for more than 48 h. Mortality and general complications were significantly lower for percutaneous screw fixation. All kinds of joint replacement show significantly higher general and surgical complications.
  
  
  CONCLUSIONS
  The analyzed data support the rating of femoral neck fracture as requiring the intervention of urgent early surgery, as stated in the guideline. Percutaneous screw fixation can be considered for immobile and multimorbid patients with undislocated fractures. Advantages of total hip replacement compared to hemiarthroplasty cannot be supported by the QS-NRW data.
authors: Abteilung für Unfallchirurgie, Chirurgische Universitätsklinik, Knappschaftskrankenhaus Bochum-Langendreer, Universitätsklinik, Ruhr-Universität-Bochum, Bochum, Deutschland. tanja.kostuj@friedrichsheim.de
authors: T
authors: T
authors: Kostuj
authors: R
authors: R
authors: Smektala
authors: U
authors: U
authors: Schulze-Raestrup
authors: C
authors: C
authors: Müller-Mai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000401:mortality* / Q000592:standards*; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult