Geographic variation in device use for intertrochanteric hip fractures
Geographic variation in device use for intertrochanteric hip fractures
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DOI：
10.2106/jbjs.g.00414
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发表时间：
2008-04-01
影响因子：
5.3
通讯作者：
Swiontkowski, Marc F.
中科院分区：
文献类型：
--
作者：
Forte, Mary L.;Virnig, Beth A.;Swiontkowski, Marc F.
背景资料：老年人髋部骨折是一种常见且昂贵的问题，其中转子间骨折几乎占这些骨折的一半。大多数转子间骨折采用钢板螺钉或髓内钉治疗。我们评估了2000年至2002年医疗保险受益者中使用髓内钉治疗股骨转子间骨折的地理差异程度。方法：Medicare 100%档案（医院和医生索赔，和登记）2000年至2002年用于确定受益人，65岁或以上，患者曾接受住院手术，用钢板螺钉器械或髓内钉治疗股骨转子间骨折。在调整患者年龄、性别、种族、转子下骨折、合并症和医疗补助辅助后，我们使用多元逻辑回归分析，按州和年份对髓内钉（而不是接骨板和螺钉器械）的使用进行建模。报告了接受髓内钉器械的比值比。报告了2000年至2002年每100名医疗保险股骨粗隆间骨折患者的髓内钉调整率。结果：在这项研究中，2000年至2002年212，821例股骨粗隆间骨折手术治疗患者符合纳入标准。在所有年份中，不同州的髓内钉使用存在相当大的地理差异。在全国范围内，每100名患有转子间骨折的医疗保险患者的平均调整后髓内钉固定率从2000年的7.84增加到2002年的16.98。2000年，16个州的外科医生在每20名患有转子间骨折的医疗保险患者中使用髓内钉的不到1人。到2002年，只有两个州的外科医生在每20例股骨粗隆间骨折患者中使用髓内钉不到1例，而在8个州，每4例股骨粗隆间骨折患者中使用髓内钉超过1例。从2000年到2002年，不同州髓内钉的使用存在很大的地理差异，这在很大程度上不能用患者来解释。相关因素。
Background: Hip fractures in the elderly are a common and costly problem, with intertrochanteric fractures accounting for almost half of these fractures. Most intertrochanteric fractures are treated with either a plate-and-screw device or an intramedullary nail device. We assessed the degree of geographic variation in use of intramedullary nailing for intertrochanteric femoral fractures among Medicare beneficiaries between 2000 and 2002.Methods: Medicare 100% files (hospital and physician claims, and enrollment) for 2000 through 2002 were used to identify beneficiaries, sixty-five years of age or older, who had undergone inpatient surgery for the treatment of an intertrochanteric femoral fracture with a plate-and-screw device or an intramedullary nail. We used multiple logistic regression analysis to model the use of an intramedullary nail (as opposed to a plate-and-screw device) by state and year, after adjusting for patient age, sex, race, subtrochanteric fracture, comorbidities, and Medicaid-administered assistance. The odds ratios of receiving an intramedullary nail device are reported. The adjusted state rates of intramedullary nailing per 100 Medicare patients with an intertrochanteric fracture are reported for 2000 through 2002.Results: In this study, 212,821 claims for operations to treat patients with an intertrochanteric fracture from 2000 through 2002 met the inclusion criteria. There was considerable geographic variation in intramedullary nail use by state across all years. The mean adjusted intramedullary nailing rate per 100 Medicare patients with an intertrochanteric fracture increased nationally from 7.84 in 2000 to 16.98 in 2002. In 2000, surgeons in sixteen states used an intramedullary nail in fewer than one of every twenty Medicare patients with an intertrochanteric fracture. By 2002, surgeons in only two states used an intramedullary nail in fewer than one of every twenty patients with an intertrochanteric fracture, and in eight states they used an intramedullary nail in more than one of every four patients with an intertrochanteric fracture.Conclusions: There was substantial geographic variation in the use of intramedullary nailing by state from 2000 through 2002 that was largely not explained by patient-related factors.