PMD7 ONE-YEAR COMPLICATIONS AND REIMBURSEMENT AFTER INTRAMEDULLARY NAIL FIXATION FOR DISTAL FEMUR FRACTURES AMONG THE MEDICARE POPULATION

Abstract

Fractures of the distal femur, and their treatment with an intramedullary nail, are becoming increasingly more common. This study evaluated the one-year incidence of complications and their associated costs (reimbursement) for patients treated with an intramedullary nail(IMN) for fixation of distal femur fracture(). This retrospective observational cohort analysis used patient-level data from the Medicare Standard Analytic File(2015Q4 to 2018Q1). Patients were 65 years of age or older with an insurance claim for DFF and an IMN procedure during the episode of care for which Medicare was the primary payor. One-year post-fixation incidence for infection, deep infection, delayed healing, and nonunion were quantified. One-year post index reimbursement related to these complications was calculated when any of these complications were listed as primary on any insurance claim. Subgroup analysis was performed for patients with evidence of a prior total knee arthroplasty(TKA) on the same side as the DFF. A total of 3,070 patients had an IMN procedure for a DFF diagnosis and were included in the analysis; among these patients 8.0%(n=247 ) had a prior TKA. The mean (standard deviation [SD]) age for the cohort was 80(8.8) years. Eighty-three percent of the cohort was female, and most patients had a closed fracture(96.4%). The one-year incidence of complications was 3.3% for delayed healing, 3.0% for nonunion, 1.5% for deep infection, and 1.4% for infection. The respective mean(SD) one-year reimbursement for these complications was as follows: delayed healing $1,794($3,454), nonunion $7,027($11,915), deep infection $6,496($9,793), and infection $18,949($21,858). With the exception of nonunion, all other evaluated complications were similar or lower 1-year reimbursement rates among those with evidence of a prior TKA. Complications following DFF are costly and in the case of nonunion having a prior TKA increases the financial burden. Improved surgical methods and technologies could reduce these complications thereby reducing healthcare system costs.