Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA.
J Arthroplasty. 2020 Aug;35(8):2144-2148.e3. doi: 10.1016/j.arth.2020.03.006. Epub 2020 Mar 10.
The changing evaluation of provider metrics and payments in total hip arthroplasty (THA) necessitates current information for leaders in advocacy and policy. This study aims to use a contemporary nationwide cohort to compare and quantify the differences between the preoperative profile and clinical outcomes of THA performed for elective indications and for femoral neck fractures.
Patient records from 2007 to 2017 were queried from an administrative claims database of privately insured patients comparing THA performed for femoral neck fractures vs elective indications. Ninety-day readmission rates as well as in-hospital and 90-day postdischarge rates of local and systemic complications were collected and compared with multivariate logistic regression.
Of 83,319 primary THAs, 6895 (8.3%) were fracture cases and 76,424 (91.7%) were elective. A greater proportion of fracture patients were older, female, not obese, and had a higher burden of comorbidities (all P < .001). Fracture patients had significantly higher average lengths of stay and complication rates for all perioperative and postoperative joint and systemic complications measured (all P < .001) as well as 90-day cost (32,228 vs 22,917 USD, P < .001).
Fracture patients are inherently more difficult cases to manage as surgeons. The results of these data may have significance in improving care coordination and provide evidence for further risk adjustment in payment models. Leaders in advocacy and policy should consider patient-level risk adjustments within alternative payment models to account for the increased association of complications, length of stay, readmission rate, and comorbidities in fracture patients receiving THA compared to elective patients.
全髋关节置换术（THA）中对提供者指标和支付方式的评估不断变化，这就需要倡导和政策领域的领导者掌握当前的信息。本研究旨在利用当代全国性队列，比较和量化因选择适应证和股骨颈骨折而接受 THA 的患者术前特征和临床结局的差异。
从私人保险患者的行政索赔数据库中查询了 2007 年至 2017 年的患者记录，比较了因股骨颈骨折和选择适应证而接受 THA 的患者。收集并比较了 90 天再入院率以及院内和 90 天出院后局部和全身并发症的发生率，并采用多变量逻辑回归进行分析。
在 83319 例初次 THA 中，6895 例（8.3%）为骨折病例，76424 例（91.7%）为选择适应证病例。骨折患者年龄更大、女性更多、非肥胖且合并症负担更重（均 P <.001）。与所有测量的围手术期和术后关节及全身并发症以及 90 天费用（32228 美元比 22917 美元，P <.001）相关的骨折患者的平均住院时间和并发症发生率均显著更高。
对于外科医生来说，骨折患者是更难处理的固有病例。这些数据的结果可能对改善护理协调具有重要意义，并为支付模式中的进一步风险调整提供证据。倡导和政策领域的领导者应考虑在替代支付模式中进行患者层面的风险调整，以考虑到与选择适应证的患者相比，接受 THA 的骨折患者的并发症、住院时间、再入院率和合并症发生率增加的情况。
