{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T12:35:41Z","timestamp":1793277341497,"version":"4.5.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To investigate the effect surgical approach has on discharge disposition after hip hemiarthroplasty (HHA) treatment of femoral neck fractures (FNF) in the geriatric population.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective comparative cohort.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Level 1 trauma center.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n Patients 65 years old and older who had a FNF (OTA\/AO 31-B) treated with a HHA via the anterolateral approach (ALA), direct anterior approach (DAA), or posterolateral approach (PLA) between 2\/1\/2017 and 2\/1\/2021.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n Demographics, discharge disposition, operative timing, inpatient outcomes, and postoperative complications were measured. Outcomes were compared with PLA differentiated into PLA1 and PLA2 to correspond with the time periods that ALA and DAA were performed, respectively.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n A total of 277 patients (34 ALA, 101 PLA1, 38 DAA, and 104 PLA2) were included. Patients' age (ALA = 79.1 vs. PLA1 = 78.4 vs. DAA = 80.4 vs. PLA2 = 81.1 years;\n P<\/jats:italic>\n = 0.069), sex (ALA = 82.4% vs. PLA1 = 70.3% vs. DAA = 71.1% vs. PLA2 = 75.0%;\n P<\/jats:italic>\n = 0.517), and American society of anesthesiologists score (ALA = 3.1 vs. PLA1 = 3.1 vs. DAA = 3.0 vs. PLA2 = 3.0;\n P<\/jats:italic>\n = 0.953) were similar. Operative time (ALA = 72.3 vs. PLA1 = 74.6 vs. DAA = 79.3 vs. PLA2 = 73.7 minutes;\n P<\/jats:italic>\n = 0.232), transfusion rate (ALA = 0.0% vs. PLA1 = 8.0% vs. DAA = 5.3% vs. PLA2 = 4.8%;\n P<\/jats:italic>\n = 0.345), 30-day readmission rate (ALA = 5.9% vs. PLA1 = 5.9% vs. DAA = 15.8% vs. PLA2 = 8.7%;\n P<\/jats:italic>\n = 0.289), 1-year reoperation rate (ALA = 2.9% vs. PLA1 = 1.0% vs. DAA = 0.0% vs. PLA2 = 3.8%;\n P<\/jats:italic>\n = 0.393), and 1-year mortality (ALA = 20.6% vs. PLA1 = 26.7% vs. DAA = 31.6% vs. PLA2 = 30.8%;\n P<\/jats:italic>\n = 0.635) were similar. Discharge rates to a skilled nursing facility were significantly lower for DAA when compared with ALA (71.1% and 94.1%;\n P<\/jats:italic>\n = 0.021).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Treatment of FNF with HHA via the DAA resulted in a significantly lower rate of disposition to skilled nursing facility compared with ALA.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000003076","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T13:00:26Z","timestamp":1758286826000},"page":"e17-e20","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Diminished Admission to Skilled Nursing Facility After the Use of Direct Anterior Approach for Treating Femoral Neck Fractures in a Geriatric Population"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3296-7545","authenticated-orcid":false,"given":"Devon R.","family":"Pekas","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, Roanoke, VA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Griffin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, Roanoke, VA; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor M.","family":"Owen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, Roanoke, VA; and"},{"name":"Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20251212","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1056\/NEJMcp1611090","article-title":"Management of acute hip fracture","volume":"377","author":"Bhandari","year":"2017","journal-title":"N Engl J Med"},{"key":"R2-20251212","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s11657-018-0515-8","article-title":"In-hospital care, complications, and 4-month mortality following a hip or proximal femur fracture: the Spanish registry of osteoporotic femur fractures prospective cohort study","volume":"13","author":"Prieto-Alhambra","year":"2018","journal-title":"Arch Osteoporos"},{"key":"R3-20251212","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.injury.2020.03.031","article-title":"Complications following hip fracture: results from the world hip trauma evaluation cohort study","volume":"51","author":"Goh","year":"2020","journal-title":"Injury"},{"key":"R4-20251212","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1177\/1120700019872117","article-title":"Direct anterior versus posterolateral approach for bipolar hip hemiarthroplasty in femoral neck fractures: a prospective randomised study","volume":"30","author":"Verzellotti","year":"2020","journal-title":"Hip Int"},{"issue":"1","key":"R5-20251212","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1186\/s12916-023-02958-9","article-title":"Zullo evaluation of post-acute care and one-year outcomes among Medicare beneficiaries with hip fractures: a retrospective cohort study","volume":"21","author":"Melissa","year":"2023","journal-title":"BMC Med"},{"key":"R6-20251212","doi-asserted-by":"crossref","first-page":"e1091","DOI":"10.3928\/01477447-20151120-05","article-title":"Short-term outcomes of femoral neck fractures treated with hemiarthroplasty using the anterior approach","volume":"38","author":"Trinh","year":"2015","journal-title":"Orthopedics"},{"key":"R7-20251212","doi-asserted-by":"crossref","first-page":"358","DOI":"10.3109\/17453674.2014.1002987","article-title":"Direct anterior Hueter approach is a safe and effective approach to perform a bipolar hemiarthroplasty for femoral neck fracture: outcome in 82 patients","volume":"86","author":"Langlois","year":"2015","journal-title":"Acta Orthop"},{"key":"R8-20251212","first-page":"1257","article-title":"Does the choice of approach for hip hemiarthroplasty in geriatric patients significantly influence early postoperative outcomes? 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