PMS39 - Direct Medical Resource Utilization For Reoperation After Intramedullary Fixation of Pertrochanteric HIP Fractures

Abstract

To assess patient survival, reoperation rates, and direct medical resource utilization after reoperation subsequent to intramedullary fixation for patients with pertrochanteric femur fractures. This study used a retrospective cohort design with the United States Centers for Medicare and Medicaid (CMS) Standard Analytic File (5%) sample. Patients aged 65+ who received an ORIF with intramedullary fixation in 2013 were included in the cohort. Overall survival, reoperation events, and direct medical resource utilization (claim payments) across multiple settings of care were explored for the 90-day period after index hospitalization and for the subset of patients who underwent reoperation. Patient survival through 365 days of index surgery was analyzed using Kaplan-meier methods with stratification for baseline Charlson Comorbidity Index (CCI). 3,175 patients underwent index surgery during 2013. Patients had mean (SD) age of 83.4 (7.7), 74.1% were female, and 85.2% had a primary International Classification of Disease, 9th revision (ICD-9-CM) diagnosis code of 820.21: Closed fracture of intertrochanteric section of neck of femur. A total of 131 patients (4.1%) had a second hip surgery within 365 days after their index procedure: 51 (38.9%) contralateral, 35 (26.7%) ipsilateral and 45 (34.3%) of unknown laterality. Overall survival among the full cohort was 72.8% at 365 days, and differed across baseline CCI categories: 0-1: 83.2%; 2-3: 75.7%; 4-5: 69.5%; 6+: 58.3% (log-rank test; p <0001). For patients with ipsilateral hip reoperation, mean (SD) Medicare payments from index through the 90-day window totaled $46,577 ($26,607), and comprised the following: index hospitalization-$14,785 ($4,542); physician-$5,159 ($3,925); durable medical equipment-$203 ($536); home health-$2,936 ($3,802); skilled nursing facility-$12,002 ($11,656); inpatient rehab-$4,206 ($11,904); hospice-$326 ($1,365); and other inpatient admissions- $6,960 ($15,127). Mortality for patients with intramedullary fixation varies inversely with baseline CCI, and post-acute care accounts for nearly 60% of 90-day episode costs for patients requiring reoperation.