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The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis.
J Arthroplasty. 2017 09; 32(9S):S3-S7.JA

Abstract

BACKGROUND

Hip fracture is an increasingly common expanded indication for total hip arthroplasty (THA) and warrants outcome analysis so as to best inform risk assessment models, public reporting of outcome, and value-based reimbursement schemes.

METHODS

The National Surgical Quality Improvement Program data file from 2011 to 2014 was used to identify all patients undergoing THA via current procedural terminology code 27130. Propensity score matching in a 1:5 fashion was used to compare 2 cohorts: THA for osteoarthritis and THA for fracture. Primary outcomes included Centers for Medicare and Medicaid Services (CMS) reportable complications, unplanned readmission, postsurgical length of stay, and discharge destination. χ2 tests for categorical variables and Student t test for continuous variables were used to compare the 2 cohorts and adjusted linear regression analysis used to determine the association between hip fracture and THA outcomes of interest.

RESULTS

A total of 58,302 patients underwent elective THA for osteoarthritis and 1580 patients underwent THA for hip fracture. Rates of CMS-reported complications (4.0% vs 10.7%; P < .001), non-homebound discharge (39.8% vs 64.7%; P < .001), readmission (4.7% vs 8.0%; P < .001), and mean days of postsurgical hospital stay (3.2 vs 4.4; P < .001) were greater in the hip fracture cohort. THA for hip fracture was significantly associated with increased risk of CMS-reportable complications (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.17-3.28), non-homebound discharge (OR, 1.73; 95% CI, 1.39-2.15), and readmission (OR, 2.78; 95% CI, 2.46-3.12).

CONCLUSION

Our findings support recent advocacy for the exclusion of THA for fracture from THA bundled pricing methodology and public reporting of outcomes.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28285039

Citation

Qin, Charles D., et al. "The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture Vs Osteoarthritis." The Journal of Arthroplasty, vol. 32, no. 9S, 2017, pp. S3-S7.
Qin CD, Helfrich MM, Fitz DW, et al. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis. J Arthroplasty. 2017;32(9S):S3-S7.
Qin, C. D., Helfrich, M. M., Fitz, D. W., Hardt, K. D., Beal, M. D., & Manning, D. W. (2017). The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis. The Journal of Arthroplasty, 32(9S), S3-S7. https://doi.org/10.1016/j.arth.2017.01.049
Qin CD, et al. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture Vs Osteoarthritis. J Arthroplasty. 2017;32(9S):S3-S7. PubMed PMID: 28285039.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis. AU - Qin,Charles D, AU - Helfrich,Mia M, AU - Fitz,David W, AU - Hardt,Kevin D, AU - Beal,Matthew D, AU - Manning,David W, Y1 - 2017/02/06/ PY - 2016/11/22/received PY - 2017/01/15/revised PY - 2017/01/29/accepted PY - 2017/3/13/pubmed PY - 2018/4/18/medline PY - 2017/3/13/entrez KW - complications KW - economics KW - hip KW - practice management KW - primary SP - S3 EP - S7 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 32 IS - 9S N2 - BACKGROUND: Hip fracture is an increasingly common expanded indication for total hip arthroplasty (THA) and warrants outcome analysis so as to best inform risk assessment models, public reporting of outcome, and value-based reimbursement schemes. METHODS: The National Surgical Quality Improvement Program data file from 2011 to 2014 was used to identify all patients undergoing THA via current procedural terminology code 27130. Propensity score matching in a 1:5 fashion was used to compare 2 cohorts: THA for osteoarthritis and THA for fracture. Primary outcomes included Centers for Medicare and Medicaid Services (CMS) reportable complications, unplanned readmission, postsurgical length of stay, and discharge destination. χ2 tests for categorical variables and Student t test for continuous variables were used to compare the 2 cohorts and adjusted linear regression analysis used to determine the association between hip fracture and THA outcomes of interest. RESULTS: A total of 58,302 patients underwent elective THA for osteoarthritis and 1580 patients underwent THA for hip fracture. Rates of CMS-reported complications (4.0% vs 10.7%; P < .001), non-homebound discharge (39.8% vs 64.7%; P < .001), readmission (4.7% vs 8.0%; P < .001), and mean days of postsurgical hospital stay (3.2 vs 4.4; P < .001) were greater in the hip fracture cohort. THA for hip fracture was significantly associated with increased risk of CMS-reportable complications (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.17-3.28), non-homebound discharge (OR, 1.73; 95% CI, 1.39-2.15), and readmission (OR, 2.78; 95% CI, 2.46-3.12). CONCLUSION: Our findings support recent advocacy for the exclusion of THA for fracture from THA bundled pricing methodology and public reporting of outcomes. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28285039/The_Lawrence_D__Dorr_Surgical_Techniques_&_Technologies_Award:_Differences_in_Postoperative_Outcomes_Between_Total_Hip_Arthroplasty_for_Fracture_vs_Osteoarthritis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(17)30081-5 DB - PRIME DP - Unbound Medicine ER -