Surgical treatment variation of displaced femoral neck fractures in certified “centres for geriatric trauma” and arthroplasty centers in Germany

There is a special certification structure in Germany in which clinics can be certified either as TraumaZentrum DGU®, AltersTraumaZentrum DGU® or arthroplasty center, among others. Geriatric patients with displaced femoral neck fractures represent a highly relevant entity for trauma centers, whose structural and process quality can be validated within the framework of certification as both an AltrsTraumaZentrum DGU® (ATZ) and endoprosthetic center (EPZ).Objective: Is there a treatment variation between certified geriatric trauma centers and dual certified geriatric and arthroplasty centers?Material&Methods: Data from the ATR-DGU were analyzed from 46 clinics with ATZ and 52 clinics with ATZ+EPZ. The follow-up period included both the in-hospital stay and a 120-day interval. The primary outcome was mortality, secondary endpoints included mobility, reoperations and health status. Univariate and multivariate analyzes were performed to calculate odds ratios (ORs) after adjustment for age, gender, ASA score and concomitant injuries.The median age of the collective was 84 years, 29.6% and 29.8% were male, the median time until surgery was 20.9 hours (ATZ) vs. 20.5 hours (ATZ+EPZ). The rate of internal fixation was significantly increased in ATZs compared to clinics with dual certification (ATZ: 8.6% vs. ATZ+EPZ: 2.6%; OR=3.63). The re-operation rate was comparable in the primary stay (3.7% vs. 3.9%). Revisions due to periprosthetic fractures occurred more frequently in ATZs (8.2% vs. 3.5%). The multivariate analysis showed an increased mortality in the acute phase (OR 1.26; 1.02-1.56; p=0.031), an increased rate of re-operations in the 120-day course (OR 1.45; 1.06-2.02; p=0.024) and inpatient readmissions (OR 1.42, 1.02-2.00; p=0.043).Conclusion: In Germany, an institutional treatment variation for geriatric displaced femoral neck fractures exists. In certified geriatric trauma centers without certified arthroplasty center, there is a significantly increased rate of internal fixation with effects in terms of morbidity and mortality in the acute phase.None