Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture
| Autor: | Joshua G. Vose, Ryan M. Nunley, Christine I. Nichols |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Arthroplasty Replacement Hip Medicare Patient Readmission Cohort Studies 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Pelvic Bones Diagnosis-Related Groups Aged Retrospective Studies Aged 80 and over Hip surgery 030222 orthopedics Hip fracture Hip Fractures business.industry Incidence Incidence (epidemiology) Bundled payments medicine.disease Hospitals Patient Discharge United States Femoral Neck Fractures Surgery Hospitalization Multivariate Analysis Cohort Costs and Cost Analysis Health Resources Resource use Female Hemiarthroplasty Health Expenditures Complication business Delivery of Health Care Subacute Care Hip Injuries Total hip arthroplasty |
| Zdroj: | The Journal of Arthroplasty. 32:S128-S134 |
| ISSN: | 0883-5403 |
| DOI: | 10.1016/j.arth.2017.01.023 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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