Rural Residential Status Does Not Impact 1-Year Mortality Rates Following Proximal Femur Fracture Fixation

Abstract

Purpose: To investigate the relationship between rural residential status and 1-year all-cause mortality rates in geriatric patients following operative fixation of proximal femur fractures. Methods: A retrospective review was conducted on geriatric patients (≥65 years old) presenting with proximal femur fractures at a midwestern Level 1 trauma center between Jan. 1, 2019, to Jan. 1, 2023. Patient demographics, fracture classification, socioeconomic status (National Area Deprivation Index [ADI] quartile), and residential status (Rural Urban Commuting Area [RUCA]) were collected. Patients were categorized by ADI quartiles and RUCA scores to assess socioeconomic and residential impacts on outcomes. Results: Of the 605 patients, 505 (83.5%) survived past 1 year. Patients who died within 1 year were significantly older (90.6 ± 8.1 years), more likely to be female, and had shorter hospital stays (6.2 ± 5.6 days) compared to survivors (79.8 ± 8.9 years, 7.2 ± 5.6 days). Socioeconomic deprivation residential status and rural status were not significantly associated with 1-year mortality rates. There were no significant differences in outcomes based on race, insurance status, or tobacco use. Conclusions: The study found no significant difference in 1-year all-cause mortality rates between rural and urban geriatric patients following operative fixation of proximal femur fractures. Contrary to previous findings, higher ADI scores and rural residence were not associated with increased mortality.