Sutter Health, Carmichael, CA, USA.
MedTech Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA.
BMC Musculoskelet Disord. 2022 Sep 1;23(1):828. doi: 10.1186/s12891-022-05772-1.
Hip fractures are common in elderly populations and can be life threatening. Changes in healthcare delivery and outcomes for patients with hip fracture treated with intramedullary nails are not well characterized. The objectives of our study were: 1) the characterization of patients treated with the Trochanteric Fixation Nail -Advanced™(TFNA) Proximal Femoral Nailing System or comparable nails (index) and estimate 12-month all-cause readmissions (ACR) and reoperations following index; and 2) the evaluation of 10-year healthcare utilization (HCU) trends for treatment of femoral fractures with femoral nails.
This is a retrospective database analysis using the Premier hospital database. All adults with femoral fracture treated with an intramedullary nail, from 2010 to Q3 2019, in the inpatient setting, were identified. Exclusion criteria included patients with bilateral hip surgery and presence of breakage at time of initial surgery. The primary outcome was ACR and reoperation, the secondary outcomes were healthcare utilization metrics. Variables included demographics, comorbidities (Elixhauser Index (EI)), surgical intervention variables and hospital characteristics.
Forty-one thousand one hundred four patients were included in the study, of which 14,069 TFNA patients, with average age 77.9 (Standard deviation (SD): 12.0), more than 60% with 3 or more comorbidities (more than 64% for TFNA), 40% with severe or extreme disease severity and one third with severe or extreme risk for mortality. ACR reached 60.1% (95% confidence interval (CI): 59.6%-60.5%) - for TFNA: 60.0% (95%CI: 59.2%-60.8%). The reoperation rate was 4.0% (95%CI: 3.8%-4.2%) - for TFNA: 3.8% (95%CI: 3.5%-4.1%). Length of stay (LOS) averaged 5.8 days (SD: 4.8), and 12-month hip reoperation was 4.0% (3.8%-4.2%), in TFNA cohort: 3.8% (3.5%-4.1%). From 2010 to 2019: the percentage patients operated within 48 h of admission significantly increased, from 75.2% (95%CI: 74.3%-76.1%) to 84.3% (95%CI: 83.9%-84.6%); LOS significantly decreased, from 6.2 (95%CI: 6.0-6.4) to 5.6 (95%CI: 5.5-5.7) days; discharge to skilled nursing facilities (SNF) increased from 56.0% (95%CI: 54.8%-57.2%) to 61.5% (95%CI: 60.8%-62.2%); ACR rates decreased but reoperation rates remained constant.
ACR and reoperation rates were similar across device types and averaged 60.1% and 4.0%, respectively. Ten-year analyses showed reductions in hospital HCU and greater reliance on SNF.
髋部骨折在老年人群中很常见，可能危及生命。接受髓内钉治疗的髋部骨折患者的医疗保健服务提供方式和治疗结果的变化尚不清楚。我们研究的目的是：1）描述使用 Trochanteric Fixation Nail -Advanced™（TFNA）股骨近端髓内钉系统或类似髓内钉（指数）治疗的患者特征，并估计指数治疗后 12 个月的全因再入院率（ACR）和再手术率；2）评估 10 年来使用股骨钉治疗股骨干骨折的医疗保健利用（HCU）趋势。
这是一项使用 Premier 医院数据库的回顾性数据库分析。从 2010 年至 2019 年第三季度，在住院环境中，确定了所有接受髓内钉治疗的股骨干骨折的成年人。排除标准包括双侧髋关节手术和初次手术时存在器械断裂的患者。主要结局是 ACR 和再手术，次要结局是医疗保健利用指标。变量包括人口统计学、合并症（Elixhauser 指数（EI））、手术干预变量和医院特征。
研究共纳入 41104 例患者，其中 14069 例接受 TFNA 治疗，平均年龄为 77.9（标准差（SD）：12.0），超过 60%的患者有 3 种或以上合并症（TFNA 患者超过 64%），40%的患者病情严重或极度严重，三分之一的患者死亡风险严重或极度严重。ACR 达到 60.1%（95%置信区间（CI）：59.6%-60.5%）-对于 TFNA：60.0%（95%CI：59.2%-60.8%）。再手术率为 4.0%（95%CI：3.8%-4.2%）-对于 TFNA：3.8%（95%CI：3.5%-4.1%）。平均住院时间（LOS）为 5.8 天（SD：4.8），12 个月髋关节再手术率为 4.0%（3.8%-4.2%），在 TFNA 组：3.8%（3.5%-4.1%）。从 2010 年到 2019 年：入院后 48 小时内接受手术的患者比例显著增加，从 75.2%（95%CI：74.3%-76.1%）增加到 84.3%（95%CI：83.9%-84.6%）；LOS 显著下降，从 6.2（95%CI：6.0-6.4）下降到 5.6（95%CI：5.5-5.7）天；出院至康复护理机构（SNF）的比例从 56.0%（95%CI：54.8%-57.2%）增加到 61.5%（95%CI：60.8%-62.2%）；ACR 率下降，但再手术率保持不变。
不同器械类型的 ACR 和再手术率相似，分别为 60.1%和 4.0%。10 年分析显示，医院的 HCU 减少，对康复护理机构的依赖增加。
