Comparing survival rates and mortality in operative vs. non-operative treatment for femoral neck fractures in Alzheimer’s disease patients: a retrospective cohort study

Abstract

Abstract Background. This study aims to assess the differences in survival rates and mortality outcomes between operative surgery and non-operative treatment approaches for patients diagnosed with Alzheimer's disease (AD) who have sustained femoral neck fractures. Given the complexities of treating patients with AD who experience ground level falls, understanding the variations in post-fracture survival rates, mortality, and hazard ratios within this population remains limited. Methods. This retrospective cohort study compared the mortality, hazard ratio and survival rate between operative treatment and non-operative treatment, controlling for patients’ demographic information and baseline health status. The study population consisted of Optum beneficiaries diagnosed with AD, who experienced an initial femoral neck fracture claim between January 1, 2012, and December 31, 2017. Claims records with diagnosis and procedure codes corresponding to AD and femoral neck fracture were included; combination of hip fracture sections and pathological hip fractures were excluded. Kaplan-Meier survival curve and log-rank test were applied to compare post fracture survival rates and mortality between the treatment groups. Cox regression was applied to examine the survival period by controlling the covariates. Results. Out of the 4,157 AD patients with femoral neck fractures, 59.8% were female (n = 2,487). The median age was 81 years. The one-year survival rate for non-operative treatment (70.19%) was significantly lower than that for internal fixation (75.27%) and arthroplasty treatment (82.32%). The arthroplasty surgical group exhibited the lowest mortality rate compared to the internal fixation and non-operative groups (mortality rate: 0.0215 vs 0.0243 vs 0.0246). Conclusions. The findings suggest that the operative treatment group experiences higher survival rates and lower mortality rates when compared to the non-operative group. Treating femoral neck fractures presents a substantial mortality risk for patients and places an economic burden on the healthcare system. This study offers valuable insights for healthcare providers, administrators, and policymakers in assessing optimal approaches to femoral neck fracture treatment.