title: Surgical Treatment of Femoral Neck Fractures After 24 Hours in Patients Between the Ages of 18 and 49 Is Associated With Poor Inpatient Outcomes: An Analysis of 1361 Patients in the National Trauma Data Bank.
abstract: OBJECTIVE
  To determine (1) the incidence of delayed surgical treatment, (2) risk factors associated with delayed surgical intervention, (3) inpatient adverse events and discharge disposition, and (4) the association of delayed surgery with inpatient adverse events.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  2011 and 2012 National Trauma Data Bank.
  
  
  METHODS
  All adult patients younger than 50 years of age with femoral neck fractures.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  (1) Time to surgical intervention after inpatient admission, (2) odds ratio (OR) for delayed surgery (later than 24 hours after admission), (3) incidence of inpatient adverse events and discharge disposition, (3) rates of inpatient adverse events and discharge disposition, and (4) OR for occurrence of serious adverse events, minor adverse events, and any adverse events.
  
  
  RESULTS
  Of a total of 1361 patients, 67.8% of patients underwent surgery within 24 hours of presentation. In multivariate analysis (controlling for patient and injury characteristics), Charlson comorbidity index of 3+ compared with Charlson comorbidity index of 0 (OR: 3.62), pelvic fracture (OR: 2.01), and treatment at an American College of Surgeons level I trauma center (compared with levels II-IV; OR: 1.56) were associated with delayed surgery. The overall rate of mortality and inpatient adverse events was 0.2% and 12.1%, respectively. Delayed surgery was independently associated with increased occurrence of serious adverse events, minor adverse events, and any adverse events.
  
  
  CONCLUSIONS
  Although a majority of nonelderly patients with femoral neck fractures underwent surgery within the first 24 hours of admission and had good outcomes in the short-term, certain subpopulations have a higher risk of delayed surgery. As delayed surgery is associated with worse outcomes, and short-term and long-term outcomes, efforts should focus on expediting care of these patients.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
authors.forename: Andre M
authors.initials: AM
authors.lastname: Samuel
authors.forename: Glenn S
authors.initials: GS
authors.lastname: Russo
authors.forename: Adam M
authors.initials: AM
authors.lastname: Lukasiewicz
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Webb
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.forename: Bryce A
authors.initials: BA
authors.lastname: Basques
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists / Q000401:mortality*; D055815:Young Adult