Early Surgery in Femoral Neck Fractures in Elderly: Does Preoperative ASA Score Matter?

Introduction: Early surgical treatment (within 48 hours) has been recommended for femoral neck fractures in order to avoid complications and reduce mortality rate, regardless of presence and severity of comorbidity and preoperative status (ASA score). However some studies evidenced that early surgery doesn’t always have a beneficial effect on mortality and complications. Therefore further studies could be useful in order to better assess risk related factors of patients requiring surgical treatment for femoral neck fracture. The purpose of this study is to evaluate the effect of preoperative ASA score and timing of surgery on mortality, complications and clinical outcome. Methods: All 336 patients operated in our center from January 2013 to December 2014 were selected for this retrospective study. Patients were divided in three groups as follows: group 1 patients treated within 48 hours; group 2 patients treated between 48 to 96 hours; group 3 patients treated over 96 hours. The preoperative ASA score was recorded for each patient. Complication, clinical outcome and mortality at one-year follow-up were evaluated. At follow-up ambulation was graded as: confined to bed, assisted ambulation, and normal ambulation. Complications both local (infections, malunion, dislocation) and systemic (deep vein thrombosis, pulmonary embolism, lung infections, ischemic disorders of heart) were recorded as well as number of transfusions. Statistical analysis was performed with chi square test and P value < 0.05 was regarded significant. Results: 308 patients’ data were fully available for this study. At one-year follow-up return to normal ambulation was higher for patients of group 1 as compared with group 2 and 3 and in group 2 as compared with group 3 (P = 0.04). There was no difference in mortality and return to ambulation between patients with ASA score 1 and 2 (P = 0.06); patients with ASA score ≥ 3 showed a statistically significant higher mortality (P = 0.004) and rate of complications (0.0008) regardless of timing of surgery. There was no statistically significance in blood transfusion among the three groups. Discussion and Conclusion: Clinical outcome, complications and mortality have been previously reported from many authors and most studies agreed that early surgical treatment is recommended regardless of age and preoperative status of the patient. The present study suggests that early surgical treatment is actually able to reduce mortality and complications and to improve clinical outcome in patients with better preoperative conditions, while for patients with ASA score ≥ 3 treatment within 48 hours seems not to prevent mortality and complications and improve clinical outcome.