Cargando…
National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database
BACKGROUND: Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the fa...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960302/ https://www.ncbi.nlm.nih.gov/pubmed/31966966 http://dx.doi.org/10.5312/wjo.v11.i1.18 |
_version_ | 1783487764895891456 |
---|---|
author | Boniello, Anthony J Lieber, Alexander M Denehy, Kevin Cavanaugh, Priscilla Kerbel, Yehuda E Star, Andrew |
author_facet | Boniello, Anthony J Lieber, Alexander M Denehy, Kevin Cavanaugh, Priscilla Kerbel, Yehuda E Star, Andrew |
author_sort | Boniello, Anthony J |
collection | PubMed |
description | BACKGROUND: Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated. AIM: To examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups. METHODS: We queried the Nationwide Inpatient Sample (NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS comprises a large representative sample of inpatient hospitalizations in the United States. International Classifications of Disease, Ninth Edition (ICD-9) codes were used to identify patients in our sample. Demographic variables, hospital characteristics, payer status, medical comorbidities and mortality rates were compared between the two procedures. Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized. RESULTS: Of the total 502060 patients who were treated for femoral neck fracture, 51568 (10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%. Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean length of stay (LOS) was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality. Interestingly, private insurance was an independent predictor for treatment with THA. CONLUSION: There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States, most notably in urban hospitals. HA and THA are decreasing in total charges and LOS. |
format | Online Article Text |
id | pubmed-6960302 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-69603022020-01-22 National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database Boniello, Anthony J Lieber, Alexander M Denehy, Kevin Cavanaugh, Priscilla Kerbel, Yehuda E Star, Andrew World J Orthop Case Control Study BACKGROUND: Hemiarthroplasty (HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger, ambulatory patients is not as clear. Total hip arthroplasty (THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated. AIM: To examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups. METHODS: We queried the Nationwide Inpatient Sample (NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS comprises a large representative sample of inpatient hospitalizations in the United States. International Classifications of Disease, Ninth Edition (ICD-9) codes were used to identify patients in our sample. Demographic variables, hospital characteristics, payer status, medical comorbidities and mortality rates were compared between the two procedures. Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized. RESULTS: Of the total 502060 patients who were treated for femoral neck fracture, 51568 (10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%. Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean length of stay (LOS) was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality. Interestingly, private insurance was an independent predictor for treatment with THA. CONLUSION: There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States, most notably in urban hospitals. HA and THA are decreasing in total charges and LOS. Baishideng Publishing Group Inc 2020-01-18 /pmc/articles/PMC6960302/ /pubmed/31966966 http://dx.doi.org/10.5312/wjo.v11.i1.18 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Case Control Study Boniello, Anthony J Lieber, Alexander M Denehy, Kevin Cavanaugh, Priscilla Kerbel, Yehuda E Star, Andrew National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database |
title | National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database |
title_full | National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database |
title_fullStr | National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database |
title_full_unstemmed | National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database |
title_short | National trends in total hip arthroplasty for traumatic hip fractures: An analysis of a nationwide all-payer database |
title_sort | national trends in total hip arthroplasty for traumatic hip fractures: an analysis of a nationwide all-payer database |
topic | Case Control Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6960302/ https://www.ncbi.nlm.nih.gov/pubmed/31966966 http://dx.doi.org/10.5312/wjo.v11.i1.18 |
work_keys_str_mv | AT bonielloanthonyj nationaltrendsintotalhiparthroplastyfortraumatichipfracturesananalysisofanationwideallpayerdatabase AT lieberalexanderm nationaltrendsintotalhiparthroplastyfortraumatichipfracturesananalysisofanationwideallpayerdatabase AT denehykevin nationaltrendsintotalhiparthroplastyfortraumatichipfracturesananalysisofanationwideallpayerdatabase AT cavanaughpriscilla nationaltrendsintotalhiparthroplastyfortraumatichipfracturesananalysisofanationwideallpayerdatabase AT kerbelyehudae nationaltrendsintotalhiparthroplastyfortraumatichipfracturesananalysisofanationwideallpayerdatabase AT starandrew nationaltrendsintotalhiparthroplastyfortraumatichipfracturesananalysisofanationwideallpayerdatabase |