Delayed Surgery for Femoral Neck Fractures Treated with Hemiarthroplasty: Associated Factors and Outcomes

Abstract

Introduction : Femoral neck fracture is a common condition among older adults, and timely surgi-cal management may be compromised by socioeconomic, organizational, and treatment-related factors. This study aimed to identify factors associated with delayed surgical management and to assess its impact on postoperative complications and functional outcomes. Methodology: This was a retrospective, observational, analytical study conducted at the Regional Hospital of Ziniaré, Burkina Faso, from January 1, 2021, to December 31, 2025. Patients aged ≥60 years who underwent hemiarthroplasty for femoral neck fracture were included. Surgical delay was defined as an interval of >48 hours between hospital admission and surgery. Factors associ-ated with delayed surgery were investigated using Firth’s penalized logistic regression. Functional outcomes were assessed using the Postel-Merle d’Aubigné (PMA) score. Results : A total of 78 patients were included, including 44 men (56.4%), with a mean age of 68.3 ± 11.8 years. Thirteen patients (16.7%) underwent surgery within 48 hours, whereas 65 (83.3%) underwent surgery after 48 hours. In multivariable analysis, financial difficulties (adjusted odds ratio [aOR] = 57.60; 95% confidence interval [CI]: 1.30–2557.06; p = 0.036) and prior use of tradi-tional treatment (aOR = 24.17; 95% CI: 1.31–446.69; p = 0.032) were independently associated with delayed surgery. Implant stock-out showed a trend toward an association (aOR = 15.23; 95% CI: 0.80–291.58; p = 0.071). At least one postoperative complication occurred in 24 patients (30.8%), with frequencies of 15.4% among patients undergoing surgery within 48 hours and 33.8% among those undergoing surgery after 48 hours. After adjustment, this association did not reach statistical significance (aOR = 20.39; 95% CI: 0.70–591.07; p = 0.079). In contrast, delayed sur-gery was independently associated with a non-excellent functional outcome according to the PMA score (aOR = 27.10; 95% CI: 1.08–679.56; p = 0.045). Conclusion : Delayed surgical management was common. Financial difficulties and prior use of traditional treatment were the main factors associated with delayed surgery. Addressing these barriers may facilitate earlier surgical management and potentially improve functional outcomes. Keywords: Femoral neck fracture; Surgical delay; Postoperative complications; Functional out-come.