Femoral neck fractures are particularly common traumatic events in older adults.They are divided into medial or intracapsular fractures (subcapital and midcervical with risk of aseptic necrosis of the head) and lateral or extracapsular fractures (basicervical, pertrochanteric, and subtrochanteric). In most cases, they are caused by chronic bone diseases (e.g., senile osteoporosis) and occur following low-energy trauma (accidental falls at home), predominantly in women, who often have severe osteoporosis along with internal medicine and motor coordination problems. International guidelines agree that the best treatment for femoral neck fractures is surgery;the surgical strategy depends on the type of fracture and the patient’s age;the recommended interventions are fracture reduction and prosthetic replacement. Several studies have shown that long waits for surgery increase the risk of mortality and patient disability. Consequently, the general recommendation is that patients with a femoral neck fracture undergo surgery within 24 hours of hospital admission. A wide variation in mortality rates for femoral neck fractures suggests that at least some of these deaths are potentially preventable.The 30-day mortality rate after admission for a femoral neck fracture can vary significantly between hospitals;this phenomenon, in addition to the varying quality of hospital care, may be caused by other risk factors: socioeconomic conditions, events preceding admission, and the patient’s health status. The following indicators are defined: 1) “Surgery within 2 days following a femoral neck fracture in the elderly (hospitalization facility)”: the outcome measured is the performance of the surgery within 2 days of the date of first admission, and the exposure is determined by the hospitalization facility. 2) “Thirty-day mortality after admission for femoral neck fracture”: measures the outcome starting from the date of the patient’s hospital admission.Exposure is determined by the patient’s hospitalization facility. Indicators in which the outcome is calculated starting from the date of admission are intended to provide information on the functioning of the entire hospital care process starting from the patient’s admission.Attributing the outcome to the hospitalization facility does not imply an evaluation of the care provided by that facility, but rather of the appropriateness and effectiveness of the care process that begins with the patient’s arrival at that facility. In addition, indicator 3) “Hospitalization for femoral neck fracture in elderly patients” is calculated by patient’s area of residence. This indicator measures the frequency of hospitalizations following a femoral neck fracture and therefore allows us to evaluate the quality of measures implemented at the local level to reduce this phenomenon in elderly patients. The value of the indicators may vary between regional areas and facilities;this phenomenon, in addition to the varying quality of care, may be caused by the heterogeneous distribution, due to case mix, of various risk factors such as age, gender, and patient health conditions. Following association tests between outcome trends and new clinical variables introduced into the SDO framework starting in 2018, the following indicator was also defined: 4) “Surgery within 48 hours following a fracture of the femoral neck in the elderly (hospitalization facility)”: This indicator maintains the structure and calculation methodologies previously described, and uses the date and time of admission and surgery information for the procedure in question, in order to better characterize the timeliness of the associated intervention. The Ministry of Health Decree of April 2, 2015, no.70 on hospital care standards, for the proportion of surgical interventions within 48 hours for people with femur fractures aged 65 and over, sets a minimum threshold of 60%.
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Indicators 
