Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture

• Published in: The Journal of arthroplasty Vol. 32; no. 9; pp. S128 - S134
• Main Authors: Nichols, Christine I., MA, MBA, Vose, Joshua G., MD, Nunley, Ryan M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - economics; Arthroplasty, Replacement, Hip - mortality; bundled payments; Cohort Studies; cost burden; Costs and Cost Analysis; Delivery of Health Care - economics; Delivery of Health Care - utilization; Diagnosis-Related Groups - economics; Diagnosis-Related Groups - statistics & numerical data; Female; Femoral Neck Fractures - surgery; Health Expenditures; Health Resources; Hemiarthroplasty; hip fracture; Hip Fractures - surgery; Hip Injuries - surgery; Hospitalization; Hospitals; Humans; Incidence; Male; Medicare - economics; Multivariate Analysis; Orthopedics; Patient Discharge - statistics & numerical data; Patient Readmission - economics; Patient Readmission - statistics & numerical data; Pelvic Bones - surgery; Retrospective Studies; Subacute Care; total hip arthroplasty; United States; total hip arthroplasty; bundled payments; hemiarthroplasty; hip fracture; cost burden
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.01.023

Abstract Background In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population. Methods Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline. Continuous Medicare-only enrollment was required. Complications, resource use, and mortality from admission through 90 days following discharge (follow-up) were summarized. Results Four cohorts met selection criteria for analysis: (1) hemiarthroplasty diagnosis-related group (DRG) 469 (N = 19,634), (2) hemiarthroplasty DRG 470 (N = 77,744), (3) THA DRG 469 (N = 1686), and (4) THA DRG 470 (N = 9314). All-cause mortality during the study period was 51.6%, 29.5%, 48.1%, and 24.9% with mean 90-day costs of $28,952, $19,243, $29,763, and $18,561, respectively. Most of the patients waited 1 day from admission to surgery (41%-51%). Incidence of an all-cause complication was approximately 70% in each DRG 469 cohort and 14%-16% in each DRG 470 cohort. Conclusion This study confirms patients with hip fracture are a costly subpopulation. Tailored care pathways to minimize post-acute care resource use are warranted for these patients.