Medical resource utilization and costs for intraoperative and early postoperative periprosthetic hip fractures following total hip arthroplasty in the medicare population

Abstract

This study assessed the impact of intraoperative and early postoperative periprosthetic hip fractures (PPHFx) after primary total hip arthroplasty (THA) on health care resource utilization and costs in the Medicare population. This retrospective observational cohort study used health care claims from the United States Centers for Medicare and Medicaid Standard Analytic File (100%) sample. Patients aged 65+ with primary THA between 2010 and 2016 were identified and divided into 3 groups – patients with intraoperative PPHFx, patients with postoperative PPHFx within 90 days of THA, and patients without PPHFx. A multi-level matching technique, using direct and propensity score matching was used. The proportion of patients admitted at least once to skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and readmission during the 0 to 90 or 0 to 365 day period after THA as well as the total all-cause payments during those periods were compared between patients in PPHFx groups and patients without PPHFx. After dual matching, a total 4460 patients for intraoperative and 2658 patients for postoperative PPHFx analyses were included. Utilization of any 90-day post-acute services was statistically significantly higher among patients in both PPHFx groups versus those without PPHFx: for intraoperative analysis, SNF (41.7% vs 30.8%), IRF (17.7% vs 10.1%), and readmissions (17.6% vs 11.5%); for postoperative analysis, SNF (64.5% vs 28.7%), IRF (22.6% vs 7.2%), and readmissions (92.8% vs 8.8%) (all P < .0001). The mean 90-day total all-cause payments were significantly higher in both intraoperative ($30,114 vs $21,229) and postoperative ($53,669 vs $ 19,817, P < .0001) PPHFx groups versus those without PPHFx. All trends were similar in the 365-day follow up. Patients with intraoperative and early postoperative PPHFx had statistically significantly higher resource utilization and payments than patients without PPHFx after primary THA. The differences observed during the 90-day follow up were continued over the 1-year period as well.

Is the Direct Anterior Approach to THA Cost-effective? A Markov Analysis

“…Cost parameters were derived from prior reports [10,13,22,39] (Table 1). The incremental direct and indirect costs associated with the direct anterior approach compared with the posterior approach were estimated from a financial analysis by Joseph et al [22].…”

“…They aggregated direct expenses, such as surgeon fees, implants, anesthesia and medications, as well as indirect expenses such as overhead, staff fixed salaries, space and lights. The cost of intraoperative fracture was derived from a study utilizing data from the US Centers for Medicare and Medicaid Services Standard Analytic File, which included data from Medicare Part A and Part B claims which captures Fee-for-service services [13]. Finally, the cost of revision THA was estimated based on a sample derived from the Premier Research Database, which includes clinical, demographic, and cost data from a large sample of general, non-federal, acute-care hospitals in the United States [10].…”

Undetected Intraoperative Periprosthetic Femoral Fractures in Patients Undergoing Primary Total Hip Arthroplasty: A Retrospective Case Series and Literature Review

“…Periprosthetic fracture is a severe complication of total hip arthroplasty (THA) and is sometimes catastrophic. It has become a major reason for revision surgery, accounting for 6% of revisions recorded in registries in the United States and 20% in Australia 1 ; in particular, periprosthetic femoral fracture (PFF) is an increasingly prominent cause, resulting in poor clinical outcomes and high mortality rates 2–5 …”

“…Studies have shown that the incidence of intraoperative periprosthetic femoral fractures (IPFFs) is not less than that of postoperative periprosthetic femoral fractures 6,7 . Fractures identified intraoperatively can be treated during primary surgery and have statistically significantly better treatment outcomes and a lower rate of catastrophic consequences than fractures identified postoperatively 2,7 . Those fractures that are undetected and untreated intraoperatively may result in delayed weight bearing and returning to normal activities, which sometimes need difficult and controversial management strategies and necessitate complicated and serious reoperations 8 .…”

Management of Periprosthetic Acetabular Fractures

“…This is particularly important since the number of complications following THA is predicted to increase with the rise in procedure volume. The majority of complications after THA can be avoided if they are foreseen and managed judiciously as they arise 4,8 .…”