104 Myelopathy and Increased Costs of Care After Hip Fracture

Abstract

INTRODUCTION: Cervical myelopathy, as a common cause of disability and falls in the elderly, places patients at risk for hip fracture and increased complications after hip surgery. Myelopathy’s co-incidence with hip fractures, however, is not well understood. METHODS: Medicare hip fracture and cervical myelopathy patients between 2005 and 2012 were retrospectively identified using the PearlDiver Patient Records Database (PearlDiver Technologies, Inc., CO) with ICD-9 CPT codes. Myelopathic and non-myelopathic hip fracture patients were compared by age, comorbidities, average payments, and average lengths of stay (LOS). Myelopathic patients who were treated with cervical decompression prior to hip fracture were also compared with those without prior decompression. Statistical analysis with t-test and Chi-squared test was performed, with statistical significance set at p<0.05. RESULTS: A total of 2,309,972 patients with hip fractures were identified, with 22,884 (1.0%) also having cervical myelopathy. Hip fracture patients with myelopathy were significantly younger (p<0.001) but had significantly greater incidence of medical co-morbidities (hypertension, osteoporosis) (p<0.001). Patients with concomitant myelopathy also had significantly greater average payments ($16,549.21 v. $10,300.88, p<0.001) and longer average LOS (6.66 v. 6.38 days, p<0.001). Of the myelopathic patients, 461 (2.0%) underwent cervical decompression prior to hip fracture. When compared with non-operative myelopathic patients (98%), post-decompression myelopathic hip fracture patients were seen to have increased incidence of medical comorbidities (p<0.001) but also decreased average payments ($7,376.97v. $16,607.81 p<0.001) and LOS (6.04 v. 6.67 days, p=0.011). CONCLUSION: Hip fractures in myelopathic patients are significantly more complex than hip fractures in non-myelopathic counterparts and incur significantly greater costs and longer admissions. Cervical decompression prior to hip fracture appears to decrease costs and lengths of stay in this population, suggesting faster recovery from hip fracture despite medical complexity.