Trends and benefits of early hip arthroplasty for femoral neck fracture in china: a national cohort study.

BACKGROUND: Limited studies have examined the benefits of early arthroplasty within 48 hours from admission to surgery for femoral neck fractures (FNFs). Using the national inpatient database, we aimed to investigate the trends in early arthroplasty within 48 hours for FNFs in China and to assess its effect on in-hospital complications and 30-day readmission patterns.

MATERIALS AND METHODS: This was a retrospective cohort study. Patients receiving primary total hip arthroplasty (THA) or hemiarthroplasty (HA) for FNFs in the Hospital Quality Monitoring System between 2013 and 2019 were included. After adjusting for potential confounders with propensity score matching, a logistic regression model was performed to compare the differences in in-hospital complications (i.e., in-hospital death, pulmonary embolism [PE], deep vein thrombosis [DVT], wound infection, and blood transfusion), rates and causes of 30-day readmission between early and delayed arthroplasty.

RESULTS: During the study period, the rate of early THA increased from 18.0% to 19.9%, and the rate of early HA increased from 14.7% to 18.4% (P<0.001). After matching, 11,731 pairs receiving THA and 13,568 pairs receiving HA were included. Compared with delayed THA, early THA was associated with a lower risk of PE (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.30-0.88), DVT (OR 0.59, 95% CI 0.50-0.70), blood transfusion (OR 0.62, 95% CI 0.55-0.70), 30-day readmission (OR, 0.82; 95% CI, 0.70 to 0.95), and venous thromboembolism-related readmission (OR, 0.50; 95% CI, 0.34 to 0.74). Similarly, early HA was associated with a lower risk of DVT (OR 0.70, 95% CI 0.61-0.80) and blood transfusion (OR 0.74, 95% CI 0.68-0.81) than delayed HA.

CONCLUSION: Despite a slight increase, the rate of early arthroplasty remained at a low level in China. Given that early arthroplasty can significantly improve prognosis, more efforts are needed to optimize the procedure and shorten the time to surgery.