PIT2 Descriptive Analysis of Complications, Length of STAY (LOS) and Costs of Surgical Fixation for Femoral Neck Fracture (FNF) in JAPAN

Abstract

An increase in the incidence of FNF in Japan, most of which will require surgical treatment, would add significant burden to the healthcare system. This study describes patient characteristics, complications, LOS and healthcare expenditures associated with FNF surgical fixation in Japan. Patients ≥18 years old with a primary diagnosis of FNF receiving surgical fixation between 2008-2017 were identified using the Medical Data Vision Co. Ltd. database. Surgical fixations of interest included Cannulated Cancellous Screws (CCS), Dynamic Hips Screw (DHS), Hook Pin (HP) or Hook Pin with plate (HPL). Baseline characteristics, complications, readmissions, implant revisions, LOS and healthcare expenditures were extracted. Descriptive statistics were calculated to assess these endpoints. 8,044 patients (mean age 77.0±12.9; 76.2% female) met inclusion criteria. FNF fixation with HP (45.8%) was most common, followed by CCS (34.1%), DHS (11.4%) and HPL (8.7%). The most frequent inpatient complication was blood loss requiring transfusion (7.9% CCS, 21.2% DHS, 7.4% HP and 8.2% HPL). Median (IQR; day) LOS from surgery was CCS 21 (15, 34); DHS 28 (18, 48); HP 24 (16, 39); HPL 22 (16, 35.5). The median (IQR) inpatient healthcare expenditures were ¥1,171,759 (928,632, 1,703,036) for CCS, ¥1,600,066 (1,219,870, 2,525,716) for DHS, ¥1,505,947 (1,206,093, 2,132,549) for HP and ¥1,636,166 (1,384,697, 2,337,470) for HPL. 12-month follow-up period, readmission (6.6% in CCS, 3.7% in DHS, 6.3% in HP, 5.6% in HPL) and revision rates (2.7% in CCS, 1.5% in DHS, 2.7% in HP, 4.0% in HPL) were observed by fixation type. This study highlighted shorter LOS with less invasive fixation approaches (CSS, HP and HPL) and lower incidence of readmission & revision for DHS patients in a sample of FNF patients. Future research on patient factors and fixation methods that influence healthcare resource utilization in FNF treatment is necessary to address the burden in Japan.