Increased Complications and Cost Associated With Hip Arthroplasty for Femoral Neck Fracture: Evaluation of 576,119 Medicare Patients Treated With Hip Arthroplasty.
Increased Complications and Cost Associated With Hip Arthroplasty for Femoral Neck Fracture: Evaluation of 576,119 Medicare Patients Treated With Hip Arthroplasty.
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与股骨颈骨折髋关节置换术相关的并发症和费用增加：对 576,119 名接受髋关节置换术治疗的医疗保险患者的评估。
DOI：
10.1016/j.arth.2021.12.027
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Gililland,JeremyM
中科院分区：
文献类型：
--
作者：
DeKeyser,GrahamJ;Martin,BrookI;Ko,Hyunkyu;Kahn,TimothyL;Haller,JustinM;Anderson,LucasA;Gililland,JeremyM
背景：在老年人群中，全髋关节置换术(THA)治疗骨性关节炎(OA)和股骨颈骨折(FNFS)的益处是确定的。我们比较了人工全髋关节置换术(THA)和人工全髋关节置换术(HA)治疗股骨头坏死的围手术期并发症和费用。方法使用医疗保险和医疗补助服务中心的数据来确定2013至2017年间所有65岁及以上接受初次髋关节置换术的患者。患者分为3组：全髋关节置换组(326,313例)、透明质酸组(223,811例)和全髋关节置换组(25995例)。在控制了年龄、性别、种族和合并症的情况下，使用广义回归来比较组死亡率、90天再入院日、血栓栓塞症事件和90天发病成本。结果与接受骨性关节炎治疗的患者相比，FNF患者年龄更大，合并并发症也明显更多(均P<；001)。即使在最年轻的无合并症的年龄组(65-69岁)中，FNF也与90天的死亡风险有关(THA-FNF优势比[OR]9.3，HA-FNF OR 27.0，P<；)。001)，1年(THA-FNF OR 7.8，HA-FNF OR 19.0，P<；001年)和5年(THA-FNF危险比4.5，HA-FNF危险比10.0，P<；001)。FNF的THA和HA的90天平均直接成本分别比OA的THA高12,479美元和14,036美元(均为P<；001)。结论在医疗保险和医疗补助服务中心的髋关节置换术患者中，有FNF的患者死亡率、血栓栓子事件、再入院和更高的直接成本显著较高。关节置换的补偿模式应考虑到不同患者的围手术期并发症和资源利用情况。
Background The benefit of total hip arthroplasty (THA) for treatment of osteoarthritis (OA) and femoral neck fractures (FNFs) in the geriatric population is well established. We compare perioperative complications and cost of THA for treatment of OA to hemiarthroplasty (HA) and THA for treatment of FNF. Methods Data from the Centers for Medicare & Medicaid Services were used to identify all patients 65 years and older undergoing primary hip arthroplasty between 2013 and 2017. Patients were divided into 3 cohorts: THA for OA (n= 326,313), HA for FNF (n= 223,811), and THA for FNF (n= 25,995). Generalized regressions were used to compare group mortality, 90-day readmission, thromboembolic events, and 90-day episode costs, controlling for age, gender, race, and comorbidities. Results Compared to patients treated for OA, FNF patients were older and had significantly more comorbidities (all P<. 001). Even among the youngest age group (65-69 years) without comorbidities, FNF was associated with a greater risk of mortality at 90 days (THA-FNF odds ratio [OR] 9.3, HA-FNF OR 27.0, P<. 001), 1 year (THA-FNF OR 7.8, HA-FNF OR 19.0, P<. 001) and 5 years (THA-FNF hazard ratio 4.5, HA-FNF hazard ratio 10.0, P<. 001). The average 90-day direct cost was $12,479 and $14,036 greater among THA and HA for FNF respectively compared to THA for OA (all P<. 001). Conclusion Among Centers for Medicare & Medicaid Services hip arthroplasty patients, those with an FNF had significantly higher rates of mortality, thromboembolic events, readmission, and greater direct cost. Reimbursement models for arthroplasty should account for the distinctly different perioperative complication and resource utilization for FNF patients.
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影响因子：
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