Prior Admissions as a Risk Factor for Readmission in Patients Surgically Treated for Femur Fractures: Implications for a Potential Hip Fracture Bundle

Abstract

Introduction: Hip fractures are a significant economic burden to our healthcare system. As there have been efforts made to create an alternative payment model for hip fracture care, it will be imperative to risk-stratify reimbursement for these medically comorbid patients. We hypothesized that patients readmitted to the hospital within 90 days would be more likely to have a recent previous hospital admission, prior to their injury. Patients with a recent prior admission could therefore be considered higher risk for readmission and increased cost. Methods: A retrospective chart review identified 598 patients who underwent surgical fixation of a hip or femur fracture. Data on readmissions within 90 days of surgical procedure and previous admissions in the year prior to injury resulting in surgical procedure were collected. Logistic regression analysis was used to determine if recent prior admission had increased risk of 90-day readmission. A subgroup analysis of geriatric hip fractures and of readmitted patients were also performed. Results: Having a prior admission within one year was significantly associated (p < 0.0001) for 90-day readmission. Specifically, logistic regression analysis revealed that a prior admission was significantly associated with 90-day readmission with an odds ratio of 7.2 (95% CI: 4.8-10.9). Discussion: This patient population has a high rate of prior hospital admissions, and these prior admissions were predictive of 90-day readmission. Alternative payment models that include penalties for readmissions or fail to apply robust risk stratification may unjustly penalize hospital systems which care for more medically complex patients. Conclusions: Hip fracture patients with a recent prior admission to the hospital are at an increased risk for 90-day readmission. This information should be considered as alternative payment models are developed for hip fracture care.

A retrospective analysis of healthcare costs for geriatric patients in intensive care unit following hip fracture surgery

“…Hip fractures account for only 14 percent of all fractures in the United States, yet they account for 72 percent of the costs associated with musculoskeletal fracture care (4). The average cost of treating hip fractures is estimated to be between $10 billion and $15 billion annually, and the cost is expected to rise to 240 billion by 2040 (6). Hence, thorough cost-benefit analyses of expenses and health implications are required.…”

“…However, to the best of our knowledge, no studies on the cost associated with ICU admission following hip fracture surgery in the elderly have been published. Bundled payment models for surgeries have been proposed as a way to enhance the quality of care while lowering costs (6,11,12). Patients in particular diagnosis-related groups are included in these payment models, which establish a target reimbursement based on past cost data for such a course of treatment.…”

“…Previous research has indicated that different patient demographics, comorbidities, and surgical methods result in a variety of femur fracture treatment costs (10,13,14). Studies have shown that bundled payments for hip fractures should be risk adjusted (6,13,14). This study aimed to evaluate the variables that can be used for risk assessment of bundled payment programs in the ICU.…”