Total Hip Arthroplasty for Femoral Neck Fractures: Improved Outcomes With Higher Hospital Volumes

Maceroli, Michael; Nikkel, Lucas E.; Mahmood, Bilal; Ketz, John; Qiu, Xing; Ciminelli, Joseph; Messing, Susan; Elfar, John C.

doi:10.1097/bot.0000000000000662

Cited by 33 publications

(13 citation statements)

References 34 publications

(28 reference statements)

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“…Prior studies have mainly sought to elucidate the volume-outcomes relationship, and demonstrated that an increase in the number of procedures performed is associated with improved outcomes [30e41]. Maceroli et al [33] analyzed the New York State Statewide Planning and Research Cooperative System database to determine if patient outcomes following THA performed for femoral neck fractures differed between hospitals of different case volumes. They found that patients who underwent THA at the highest volume hospitals had significantly lower 30-day/1-year mortality rates and 90-day complication rates.…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training

Padilla

Gabor

Ryan

et al. 2020

The Journal of Arthroplasty

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Background: Hip fractures have significant economic implications as a result of their associated direct and indirect medical costs. Under alternative payment models, it has become increasingly important for institutions to find avenues by which costs could be reduced while maintaining outcomes in these cases. Methods: A multi-institutional retrospective analysis of Medicare patients who underwent total hip arthroplasty (THA) for femoral neck fracture was conducted to assess the impact of fellowship training in adult reconstruction (AR) on the total costs of the 90-day episode of care. Patients were divided into 2 cohorts according to fellowship training status of the operating surgeon: (1) AR-trained and (2) other fellowship training (non-AR). The primary outcome was the total cost of the 90-day episode of care converted to a percentage of the bundled payment target price. Results: A total of 291 patients who underwent THA for the treatment of a femoral neck fracture were included. The average total cost percentage of the 90-day episode of care was significantly lower for the AR cohort 70.9% (±36.6%) than the non-AR cohort 82.6% (±36.1%) (P < .01). After controlling for baseline demographics in the multivariable logistic regression, the care episodes in which the operating surgeons were AR fellowship-trained were still found to be significantly lower, at a rate of 0.87 times the costs of the non-AR surgeons (95% confidence interval 0.78-0.97, P ¼ .011). In addition, the non-AR cohort exceeded the bundle target price more frequently than the AR cohort, 49 (28.7%) vs 16 (13.3%) (P ¼ .02). Conclusion:In an era of bundled payments, ascertaining factors that may increase the value of care while decreasing the cost is paramount for institutions and policymakers alike. The results presented in this study suggest that in the femoral neck fracture population, surgeons trained in AR achieve lower total costs for the THA episode of care. Furthermore, non-AR fellowship-trained surgeons exceeded the bundled payment target more frequently than the AR surgeons.

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Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training

Padilla

Gabor

Ryan

et al. 2020

The Journal of Arthroplasty

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“…It is commonly performed in patients to restore functional mobility of the hip joint and reduce pain. Indications for surgery include hip osteoarthritis, femoral neck fractures, avascular necrosis of the femoral head, infection, and others [2][3][4][5]. Total hip arthroplasty (THA) is regularly performed for patients with hip osteoarthritis, and it consists of replacing both bony structures of the hip joint, the femoral head and the acetabulum, with prostheses.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Effects of General Versus Regional Anesthesia on Postoperative Mortality in Total and Partial Hip Arthroplasty

Khan¹,

Noman²,

Markatia³

et al. 2021

Cureus

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Purpose Total hip arthroplasty (THA) and partial hip arthroplasty (PHA) are performed in patients with hip joint dysfunction such as osteoarthritis or hip fractures and are associated with complications including mortality. There is a lack of evidence in the literature regarding whether the type of anesthesia (regional vs. general) is associated with increased postoperative mortality in patients undergoing hip arthroplasty. The present study compares early postoperative mortality between general or regional anesthesia administered to patients undergoing either THA or PHA. Methods A retrospective cohort was assembled using the 2015-2016 American College of Surgeons National Surgical Quality Improvement Program database. Adult patients undergoing hip arthroplasty under general or regional anesthesia were included. Patients were excluded if receiving any other type of anesthesia, as well as having an American Society of Anesthesiologists (ASA) physical status classification score ≥ 4, preoperative acute renal failure, severe congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or ascites. Adjusted odds of 30 days all-cause postoperative mortality according to the type of anesthesia were estimated by fitting multiple logistic regression models that included potential confounders and effect modifiers. Results A total of 60,897 patients were included in the study. Given that the interaction between the type of anesthesia and the type of arthroplasty was statistically significant, separated models were fitted for each type of arthroplasty. There was no evidence of an association between type of anesthesia and postoperative mortality in hip arthroplasty patients regardless of whether the arthroplasty was partial (odds ratio {OR} = 0.85; confidence interval {CI} 0.59-1.22) or total (OR = 0.68; CI 0.43-1.08). Conclusion The overall early postoperative mortality in adult hip arthroplasty patients is low in the absence of risk factors such as severe CHF, COPD, ascites, acute renal failure, and ASA score of 4 or higher. Our findings suggest there is no association between the type of anesthesia received (general vs. regional) and early postoperative mortality rates in patients undergoing hip arthroplasty, regardless of type (total vs. partial).

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“…Recent evidence supports that patients treated at hospital with higher THA volume for femoral neck fractures at higher volume arthroplasty centers faired better in regard to lower mortality and 90-day complication rates. 32 In this cohort, patients treated at higher volume THA hospitals also had higher odds of THA for femoral neck fractures (OR: 1.003, P value <.0001, 95% CI: 1.002-1.003) than patients treated at hospital with lower THA volume.…”

Section: Discussionmentioning

confidence: 71%

Disparities in Total Hip Arthroplasty Versus Hemiarthroplasty in the Management of Geriatric Femoral Neck Fractures

Dangelmajer

Yang

Githens

et al. 2017

Geriatr Orthop Surg Rehabil

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Introduction:Recent clinical evidence suggests that total hip arthroplasty (THA) provides improved clinical outcomes as compared to hemiarthroplasty (HA) for displaced femoral neck fractures in elderly individuals. However, THA is still utilized relatively infrequently. Few studies have evaluated the factors affecting utilization and the role socioeconomics plays in THA versus HA.Methods:In the United States, the National Inpatient Sample (NIS) database was used to identify patients treated surgically for femoral neck fracture, between 2009 and 2010. Patients were identified using International Classification of Diseases, Ninth Revision, codes for closed, transcervical femoral neck fractures and closed fractures at unspecified parts of the femoral neck. All candidate predictors of THA versus HA were entered into a multilevel mixed-effect regression model.Results:Older patient age, being Asian or Pacific Islander, and having Medicaid payer status were all associated with lower odds of receiving THA. Patients with private insurance including Health Maintenance organization (HMO) had higher odds of THA as did patients with other insurance. Odds of THA were significantly lower among patients in teaching hospitals and higher at hospitals with greater THA volume.Discussion:Ethnicity, payer status, hospital size, and institutional THA volume were all associated with the utilization of THA versus HA in the treatment of geriatric femoral neck fractures.Level of Evidence:Level III Retrospective Cohort study.

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Total Hip Arthroplasty for Femoral Neck Fractures: Improved Outcomes With Higher Hospital Volumes

Cited by 33 publications

References 34 publications

Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training

Total Hip Arthroplasty for Femoral Neck Fracture: The Economic Implications of Orthopedic Subspecialty Training

Comparing the Effects of General Versus Regional Anesthesia on Postoperative Mortality in Total and Partial Hip Arthroplasty

Disparities in Total Hip Arthroplasty Versus Hemiarthroplasty in the Management of Geriatric Femoral Neck Fractures

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