[Does hospital structure influence the outcome of operative treatment of femoral neck fractures?].

UNLABELLED: Data on 32 007 patients suffering from a medial fracture of the femoral neck have been collected between 1993 and 1999 in a database for external quality assurance organized by the chamber of physicians in Westfalia-Lippe. A statistical analysis (ANOVA, chi-square-test) has been performed to find out whether factors like specialization, annual volume or level of the hospital (primary, secondary or tertiary hospital) influence the outcome.
RESULTS: Patients with higher preoperative risk-factors are treated more often in primary hospitals. These clinics perform conservative treatment significantly more often than tertiary hospitals (6.5 % vs. 3.8 %). Osteosyntheses are performed more often in departments specialized in traumatology (13 %) or tertiary hospitals (16.8 %). Preoperative length of stay was 0.5-0.7 days shorter in these hospitals. There is no significant difference in postoperative complications all together (23.2-25.6 %), but a significantly lower rate in postoperative complications after osteosynthesis performed by departments specialized in traumatology (11.3 % vs. 18.8 %). A volume load of more than 50 cases per year correlates with a significant decline in postoperative complications (22.5 % vs. 28.2 %). Risk adjusted mortality does not show significant differences among the different levels of hospitals.
CONCLUSIONS: There are distinct differences regarding the way of treatment and procedural quality, but not concerning the short-term outcome between hospitals of different levels.