title: Open reduction internal fixation versus hemiarthroplasty versus total hip arthroplasty in the elderly: a review of the National Surgical Quality Improvement Program database.
abstract: BACKGROUND
  Total hip arthroplasty (THA), hemiarthroplasty (HA), and open reduction internal fixation (ORIF) are treatment options for femoral neck fractures. However, the optimal surgical treatment remains unclear. The present study aimed to describe the 30-d postoperative outcomes of THA, HA, and ORIF among patients aged ≥65 y with femoral neck fractures within a national surgical database.
  
  
  METHODS
  A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program for January 2005 through December 2009 was conducted. We included patients aged ≥65 y who had undergone THA, HA, or ORIF for femoral neck fractures. We collected information on patient demographics, comorbidities, risk factors, and complication rates. A logistic regression model was used to assess the variation in overall morbidity and mortality after surgery.
  
  
  RESULTS
  Overall, 3423 patients met the inclusion criteria: 674 underwent ORIF, 428 HA, and 2321 THA. Most patients were white (83.6%, n = 2862), female (64.4%, n = 2204), and >70 y old (78.4%, n = 2682). On adjusted multivariate analysis, no differences were found in the 30-d mortality rates among the ORIF, HA, and THA groups. Patients who underwent ORIF (odds ratio 0.51, 95% confidence interval 0.27-0.94) and HA (odds ratio 0.43, 95% confidence interval 0.22-0.84) had a lower likelihood of developing respiratory complications compared with those who underwent THA.
  
  
  CONCLUSIONS
  No differences were found in the 30-d mortality rates among the ORIF, HA, and THA groups. ORIF and HA resulted in a lower likelihood of developing respiratory complications than THA.
authors.affiliation: Howard University College of Medicine, Washington, District of Columbia 20060, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Fisher
authors.forename: Jarrod D
authors.initials: JD
authors.lastname: Matthei
authors.forename: Augustine
authors.initials: A
authors.lastname: Obirieze
authors.forename: Gezzer
authors.initials: G
authors.lastname: Ortega
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Tran
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Carnegie
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Turner
authors.forename: Terrence M
authors.initials: TM
authors.lastname: Fullum
authors.forename: Marc E
authors.initials: ME
authors.lastname: Rankin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D005260:Female; D005265:Femoral Neck Fractures / Q000401:mortality / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods* / Q000401:mortality; D062785:Hemiarthroplasty / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome