205. Cervical myelopathy increases cost of care and length of stay following hip fracture

Abstract

<h3>BACKGROUND CONTEXT</h3> Hip fractures are devastating injuries for the elderly and an increasing burden to the health care system. Cervical myelopathy, as a common cause of disability, instability, and falls in this population, places patients at risk for hip fracture, and myelopathic patients are associated with increased complications after hip surgery. The precise co-prevalence of cervical myelopathy with hip fractures, as well as its impact on the health care system, however, have yet to be described. <h3>PURPOSE</h3> This study sought to determine the prevalence of cervical myelopathy among hip fracture patients and hypothesized that myelopathic hip fracture patients were associated with greater medical complexity and per-patient costs. <h3>STUDY DESIGN/SETTING</h3> Retrospective database review. <h3>PATIENT SAMPLE</h3> All Medicare beneficiaries from 2005-2012. <h3>OUTCOME MEASURES</h3> Average patient charges/payment; length of admission. <h3>METHODS</h3> In this Institutional Review Board-exempt study, Medicare patients between 2005 and 2012 were reviewed using the Medicare Standard Analytical Files with the PearlDiver Patient Records Database (PearlDiver technologies, Inc., Colorado Springs, CO). International Classification of Diseases, Ninth Revision, (ICD-9) diagnosis codes were used to identify patients with hip fractures and cervical myelopathy. Myelopathic hip fracture patients were compared with non-myelopathic hip fracture patients with regard to age, medical comorbidities, average charges/payment per patient, and length of inpatient admission. Myelopathic patients who underwent cervical decompression after hip fractures were also identified using Current Procedural Terminology (CPT) codes, and average charges/payment per patient and length-of-stay calculated. Statistical analysis with t-test and Chi-squared test was performed, with statistical significance set at p<0.05. <h3>RESULTS</h3> A total of 2,309,972 hip fracture patients from 2005-2012 were identified. Only a small fraction of this cohort carried a diagnosis of cervical myelopathy (22,884; 1.0%) compared with non-myelopathic hip fracture patients (2,287,088; 99%). Myelopathic hip fracture patients were significantly younger (p<0.001) but were also associated with significantly greater incidence of hypertension, coronary artery disease, stroke, obesity, tobacco use, diabetes, and osteoporosis (p<0.001) than their non-myelopathic counterparts. Myelopathic hip fracture patients were associated with significantly greater average charges/payments per patient ($63,694/$15,595 myelopaths vs $38,043/$9,778 non-myelopaths; p<0.001) and longer length of stays associated with their non-myelopathic counterparts (myelopaths: 6.7 days; non-myelopaths: 6.4 days; p<0.001). Spine surgery for myelopathy following hip fracture was rare; only a small proportion of myelopathic hip fracture patients went on to have cervical decompression after their injury (487 patients; 2.1%). <h3>CONCLUSIONS</h3> Hip fracture patients with cervical myelopathy carry significantly more medical comorbidities than their non-myelopathic counterparts and, despite being a small fraction of the overall hip fracture population, incur significantly greater costs and longer admissions. Cervical decompression following hip fracture is infrequent, likely relating to the challenging prognoses of these patients. These results highlight the complexity of myelopathic patients, and early treatment of cervical myelopathy should be considered an important part of hip fracture prevention strategies. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.