Demographic and clinical profile of patients treated with proximal femoral nails – a 10-year analysis of more than 40,000 Cases

Abstract

Background Hip fractures are common in elderly populations and can be life threatening. Changes in healthcare delivery and outcomes for patients with hip fracture treated with intramedullary nails are not well characterized. The objectives of our study were: 1) the characterization of patients treated with the Trochanteric Fixation Nail -Advanced™(TFNA) Proximal Femoral Nailing System or comparable nails (index) and estimate 12-month all-cause readmissions (ACR) and reoperations following index; and 2) the evaluation of 10-year healthcare utilization (HCU) trends for treatment of femoral fractures with femoral nails. Methods This is a retrospective database analysis using the Premier hospital database. All adults with femoral fracture treated with an intramedullary nail, from 2010 to Q3 2019, in the inpatient setting, were identified. Exclusion criteria included patients with bilateral hip surgery and presence of breakage at time of initial surgery. The primary outcome was ACR and reoperation, the secondary outcomes were healthcare utilization metrics. Variables included demographics, comorbidities (Elixhauser Index (EI)), surgical intervention variables and hospital characteristics. Results Forty-one thousand one hundred four patients were included in the study, of which 14,069 TFNA patients, with average age 77.9 (Standard deviation (SD): 12.0), more than 60% with 3 or more comorbidities (more than 64% for TFNA), 40% with severe or extreme disease severity and one third with severe or extreme risk for mortality. ACR reached 60.1% (95% confidence interval (CI): 59.6%-60.5%) – for TFNA: 60.0% (95%CI: 59.2%-60.8%). The reoperation rate was 4.0% (95%CI: 3.8%-4.2%) – for TFNA: 3.8% (95%CI: 3.5%-4.1%). Length of stay (LOS) averaged 5.8 days (SD: 4.8), and 12-month hip reoperation was 4.0% (3.8%-4.2%), in TFNA cohort: 3.8% (3.5%-4.1%). From 2010 to 2019: the percentage patients operated within 48 h of admission significantly increased, from 75.2% (95%CI: 74.3%-76.1%) to 84.3% (95%CI: 83.9%-84.6%); LOS significantly decreased, from 6.2 (95%CI: 6.0–6.4) to 5.6 (95%CI: 5.5–5.7) days; discharge to skilled nursing facilities (SNF) increased from 56.0% (95%CI: 54.8%-57.2%) to 61.5% (95%CI: 60.8%-62.2%); ACR rates decreased but reoperation rates remained constant. Conclusions ACR and reoperation rates were similar across device types and averaged 60.1% and 4.0%, respectively. Ten-year analyses showed reductions in hospital HCU and greater reliance on SNF.

Implantes cefálicos helicoidais na fixação das fraturas da região trocantérica do fêmur. Real benefício ou avanço apenas teórico?

“…O tratamento das fraturas da região peritrocantérica é assunto de grande relevância mundial, com enormes impactos sociais e econômicos (FINKEMEIER et al, 2022;NHERERA et al, 2018;VAN HEGHE et al, 2022;WERNER et al, 2022) VARDON, 1989;JAIN;BASINSKI;KREDER, 2003;LOGGERS et al, 2020), com diversas patologias ou estado nutricional gravemente afetado (GOISSER et al, 2015), ou mesmo em faixas etárias extremas como nonagenários e centenários (BARCELÓ et al, 2018), ainda hoje existe muita discussão sobre o melhor método a ser utilizado (FINKEMEIER et al, 2022;IRWIN et al, 2022;WERNER et al, 2015). Existe abundância de estudos com comparações entre implantes extra e intramedulares, com dados conflitantes até hoje, com diversos autores advogando que o uso indiscriminado e a "defesa" dos dispositivos intramedulares não seja proporcional aos dados fornecidos pela literatura atual (ALESSIO-MAZZOLA et al, 2022;GATHEN et al, 2022;KASSEM et al, 2022;LEWIS et al, 2022;PRAKASH et al, 2022;QUARTLEY et al, 2022), e talvez até exagerados (DARBANDI et al, 2022).…”