Patients sustaining femoral neck fractures are at substantial risk for medical complications and all-cause mortality. Hip fractures are recognized as one of the leading causes of disability among elderly adults, and contribute a sizeable expenditure to the medical system [1], [2], [3]. However, there is great variability in the setting and manner in which they are managed. The benefit of treatment at a Level 1 Trauma Center (L1TC) has been well established in younger patients sustaining life-threatening traumatic injuries, yet these benefits have not been well elucidated in the geriatric population [1], [2], [3].

The goal of a L1TC is to provide the most comprehensive care to a region's most severely injured patients. Appropriate triage is essential for the efficient and economical allocation of finite resources. Geriatric patients with hip fractures are often prioritized lower than those sustaining life-threatening traumatic injuries [4]. The benefits of prompt and expedient surgical management of hip fractures have been well described [2,4,5]. Delays in care predispose this vulnerable population to a multitude of complications including urinary tract infections, pneumonia, and decubitus ulcers, and likely increase the episode of care costs [2].

As the elderly population continues to increase, so will the frequency of hip fractures. Globally, there are projected to be 6.3 million hip fractures annually by 2050, an increase from 1.7 million in 1990 [6]. Despite hip fractures accounting for only 14% of all osteoporotic fractures occurring in the US, they are associated with 72% of the annual cost of all osteoporotic fractures, responsible for between $3 to $6 billion to the healthcare system, annually [5].

The aim of the present study is to comparatively evaluate the cost, length of stay (LOS), and in-hospital mortality, associated with femoral neck fracture management at L1TCs and non-level 1 trauma centers (nL1TC) using an inpatient statewide registry. We hypothesize that after adjusting for patient comorbidities, the treatment of geriatric femoral neck fractures at L1TCs will not be associated with clinically meaningful differences in postoperative outcomes or economic costs.