Qin Charles D, Helfrich Mia M, Fitz David W, Hardt Kevin D, Beal Matthew D, Manning David W
Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Arthroplasty. 2017 Sep;32(9S):S3-S7. doi: 10.1016/j.arth.2017.01.049. Epub 2017 Feb 6.
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.
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. χ 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.
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).
Our findings support recent advocacy for the exclusion of THA for fracture from THA bundled pricing methodology and public reporting of outcomes.
髋部骨折是全髋关节置换术（THA）越来越常见的扩展适应证，需要进行结果分析，以便为风险评估模型、结果的公开报告和基于价值的报销方案提供最佳信息。
使用2011年至2014年国家外科质量改进计划数据文件，通过当前手术操作术语代码27130识别所有接受THA的患者。采用1:5的倾向评分匹配法比较两个队列：骨关节炎THA队列和骨折THA队列。主要结局包括医疗保险和医疗补助服务中心（CMS）可报告的并发症、计划外再入院、术后住院时间和出院目的地。分类变量采用χ检验，连续变量采用Student t检验比较两个队列，并采用调整线性回归分析确定髋部骨折与感兴趣的THA结局之间的关联。
共有58302例患者因骨关节炎接受择期THA，1580例患者因髋部骨折接受THA。骨折THA队列中CMS报告的并发症发生率（4.0%对10.7%；P < 0.001）、非居家出院率（39.8%对64.7%；P < 0.001）、再入院率（4.7%对8.0%；P < 0.001）和术后平均住院天数（3.2对4.4；P < 0.001）更高。骨折THA与CMS可报告并发症风险增加（优势比[OR]，2.67；95%置信区间[CI]，2.17 - 3.28）、非居家出院（OR，1.73；95% CI，1.39 - 2.15）和再入院（OR，2.78；95% CI，2.46 - 3.12）显著相关。
我们的研究结果支持最近关于将骨折THA排除在THA捆绑定价方法和结果公开报告之外的主张。
