Higher rates of readmission following acute total hip arthroplasty versus open reduction internal fixation for elderly acetabular fractures, a national study from 2010 to 2019.

Abstract

To evaluate the initial complications and short-term readmissions and reoperations following open reduction internal fixation (ORIF) versus acute total hip arthroplasty (THA) for elderly acetabular fractures. Retrospective database review. All hospitalizations in the National Readmissions Database (NRD) and National Inpatient Sample (NIS).Patients/Participants: Patients 60 years of age or older with closed acetabular fractures managed surgically identified from the NRD or NIS between 2010 and 2019. Acute THA with or without ORIF. 30, 90 and 180-day readmissions and reoperations, index hospitalization complications. An estimated 12,538 surgically managed acetabular fractures in elderly patients occurred nationally between 2010 and 2019, with 10,008 (79.8%) undergoing ORIF and 2,529 (20.2%) undergoing THA. Length of stay was 1.7 days shorter (p<0.001) and probability of non-home discharge was reduced (OR 0.68, p=0.009) for THA patients versus ORIF patients. THA was associated with lower rates of pneumonia (4.6 vs 9.1%, p<0.001) and other respiratory complications (10.2 vs 17.6%) versus ORIF. At 30 days, THA patients had higher rates of readmission (13.9 vs 10.1%, p=0.007), related readmission (5.4 vs 1.2%, p<0.001), readmission for dislocation (3.1 vs 0.3%, p<0.001), and reoperations (2.9 vs 0.9%, p=0.002). At 180 days, THA patients had higher rates of related readmission (10.1% vs 3.9%, p<0.001), readmission for dislocation (5.1% vs 1.3%, p<0.001) and readmission for SSI (3.4 vs 0.8%, p=0.005). Acute THA is associated with lower length of stay and certain index hospitalization complications, but higher rates of readmissions for related reasons and specifically for dislocation. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.