Diminished Admission to Skilled Nursing Facility Following the Use of Direct Anterior Approach for Treating Femoral Neck Fractures in a Geriatric Population

OBJECTIVES: To investigate the effect surgical approach has on discharge disposition following hip hemiarthroplasty (HHA) treatment of femoral neck fractures (FNF) in the geriatric population. METHODS: Design: Retrospective comparative cohort. Setting: Level 1 trauma center. Patient Selection Criteria: Patients 65 years old and older who had a FNF (OTA/AO 31-B) treated with a HHA via the anterolateral approach (ALA), direct anterior approach (DAA), or posterolateral approach (PLA) between 2/1/2017 and 2/1/2021. Outcome Measures and Comparisons: Demographics, discharge disposition, operative timing, inpatient outcomes, and postoperative complications were measured. Outcomes were compared with PLA differentiated into PLA1 and PLA2 to correspond with the time periods that ALA and DAA were performed, respectively. RESULTS: 277 patients (34 ALA, 101 PLA1, 38 DAA, and 104 PLA2) were included. Patients’ age (ALA=79.1 vs. PLA1=78.4 vs. DAA=80.4 vs. PLA2=81.1 years; p = 0.069), sex (ALA=82.4% vs. PLA1=70.3% vs. DAA=71.1% vs. PLA2=75.0%; p = 0.517), and ASA score (ALA=3.1 vs. PLA1=3.1 vs. DAA=3.0 vs. PLA2=3.0; p = 0.953) were similar. Operative time (ALA=72.3 vs. PLA1=74.6 vs. DAA=79.3 vs. PLA2=73.7 minutes; p = 0.232), transfusion rate (ALA=0.0% vs. PLA1=8.0% vs. DAA=5.3% vs. PLA2=4.8%; p = 0.345), 30-day readmission rate (ALA=5.9% vs. PLA1=5.9% vs. DAA=15.8% vs. PLA2=8.7%; p = 0.289), 1-year reoperation rate (ALA=2.9% vs. PLA1=1.0% vs. DAA=0.0% vs. PLA2=3.8%; p = 0.393), and 1-year mortality (ALA=20.6% vs. PLA1=26.7% vs. DAA=31.6% vs. PLA2=30.8%; p = 0.635) were similar. Discharge rates to a skilled nursing facility (SNF) were significantly lower for DAA when compared to ALA (71.1% and 94.1%; p = 0.021). CONCLUSIONS: Treatment of FNF with HHA via the DAA resulted in a significantly lower rate of disposition to SNF compared to ALA. LEVEL OF EVIDENCE: Therapeutic Level III