Albumin and Ambulatory Status as Predictors of 5-Year Mortality After Low-Energy Femoral Neck Fractures

OBJECTIVE: Optimal management of low-energy femoral neck fractures (FNFs) in the elderly remains debated. Total hip arthroplasty (THA) is increasingly used despite evidence showing no clear advantage over hemiarthroplasty (HA) in the first 12 to 24 months and potentially higher costs and risks. Identifying objective predictors of outcomes may improve surgical decision making. This study evaluated factors associated with 1- and 5-year mortality after HA or THA. METHODS: We conducted a retrospective review of patients older than 65 years who underwent HA or THA for low-energy FNFs at a tertiary center. Preoperative, intraoperative, and postoperative variables were collected. The Fisher exact test assessed associations with 1- and 5-year mortality. Variables with P < 0.1 were entered into multivariable logistic regression using backward selection (P < 0.05 retention). RESULTS: Of 496 patients reviewed, 427 met criteria (mean age 80.3 ± 8.9 years); 295 had HA and 132 had THA. At 5 years, 193 patients had died-166 in the HA group (56.6%) and 27 in the THA group (20.5%). One-year mortality was associated with preoperative ambulatory status, age, hemoglobin, and albumin. Five-year mortality was associated with ambulatory status, age, ASA score, albumin, and BMI. Noncommunity ambulators had 4.3 times higher odds of 5-year mortality (P < 0.001). Each 1 g/dL decrease in albumin raised 5-year mortality odds by 58%. CONCLUSION: Preoperative functional and nutritional status are strong predictors of mortality after FNF surgery. These findings support the development of an evidence-based index to guide HA vs. THA selection, aiming to improve outcomes, reduce complications, and promote cost-effective care.