Mortality and Economic Burden of Revisions After Proximal Femoral Fracture Fixation
Author(s)
Jonah Hebert-Davies, MD1, N. Tracy Zheng2, Jenny Pahys, MS3, Jill Ruppenkamp, MS4, Anna Wallace, MPH, PhD5.
1UW Medicine and at Harborview Medical Center, Seattle, WA, USA, 2Raynham, MA, USA, 3Johnson & Johnson MedTech, West Chester, PA, USA, 4Johnson & Johnson, New Brunswick, NJ, USA, 5Johnson & Johnson, Titusville, NJ, USA.
1UW Medicine and at Harborview Medical Center, Seattle, WA, USA, 2Raynham, MA, USA, 3Johnson & Johnson MedTech, West Chester, PA, USA, 4Johnson & Johnson, New Brunswick, NJ, USA, 5Johnson & Johnson, Titusville, NJ, USA.
OBJECTIVES: To examine mortality and economic burden of revisions after proximal femoral fracture (PFF) fixation.
METHODS: Patients aged 65+ years with procedure and diagnosis codes indicating PFF treated with an intramedullary nail (IMN) (index surgery) were identified in the 100% Fee-for-Service Medicare Standard Analytic Files (SAF) from 1/1/2016 to 12/31/2023. Continuous Medicare Part A/B enrollment was required from 6-months before index surgery through each follow-up window. The primary outcome was total Medicare payment (proxy of resource utilization) including index surgery and through 365 days post-index surgery. We also examined 1-year mortality. Generalized Linear Models with log link and Gamma distribution were used to assess the relationship between revisions and total payment, adjusted for patient demographics, clinical characteristics, fracture location and type. We then used recycled prediction to estimate the incremental total payment associated with revisions.
RESULTS: Among 342,030 patients who underwent PFF surgery with IMN, average total payment was $31,839 at 30-days, $40,916 at 90-days and $52,562 at 365-days. Revision rates at 30-, 90-, and 365 days post-index were 0.8%, 2.1%, and 5.9%, respectively. For patients requiring revision, the incremental total payment at 30-, 90-, and 365-days post-index were $17,219 (95% CI: $16,423 - $18,014), $28,355 (95% CI: $26,982 - $29,728), and $33,324 (95% CI: $30,751 - $35,897), respectively. Among patients with 90-day survival with and without a revision within 90-days, patients with a revision had about 5% higher 1-year mortality than patients without revision (19.8% vs. 14.9%).
CONCLUSIONS: In this study of patients with PFF treated with IMN, revision was associated with elevated 1-year mortality and incremental total payment. This presents an opportunity for emerging digital technologies to provide consistency and accuracy of IMN implantation, thus potentially reducing mortality and economic burdens through reduced risk of revision.
METHODS: Patients aged 65+ years with procedure and diagnosis codes indicating PFF treated with an intramedullary nail (IMN) (index surgery) were identified in the 100% Fee-for-Service Medicare Standard Analytic Files (SAF) from 1/1/2016 to 12/31/2023. Continuous Medicare Part A/B enrollment was required from 6-months before index surgery through each follow-up window. The primary outcome was total Medicare payment (proxy of resource utilization) including index surgery and through 365 days post-index surgery. We also examined 1-year mortality. Generalized Linear Models with log link and Gamma distribution were used to assess the relationship between revisions and total payment, adjusted for patient demographics, clinical characteristics, fracture location and type. We then used recycled prediction to estimate the incremental total payment associated with revisions.
RESULTS: Among 342,030 patients who underwent PFF surgery with IMN, average total payment was $31,839 at 30-days, $40,916 at 90-days and $52,562 at 365-days. Revision rates at 30-, 90-, and 365 days post-index were 0.8%, 2.1%, and 5.9%, respectively. For patients requiring revision, the incremental total payment at 30-, 90-, and 365-days post-index were $17,219 (95% CI: $16,423 - $18,014), $28,355 (95% CI: $26,982 - $29,728), and $33,324 (95% CI: $30,751 - $35,897), respectively. Among patients with 90-day survival with and without a revision within 90-days, patients with a revision had about 5% higher 1-year mortality than patients without revision (19.8% vs. 14.9%).
CONCLUSIONS: In this study of patients with PFF treated with IMN, revision was associated with elevated 1-year mortality and incremental total payment. This presents an opportunity for emerging digital technologies to provide consistency and accuracy of IMN implantation, thus potentially reducing mortality and economic burdens through reduced risk of revision.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
MT29
Topic
Clinical Outcomes, Economic Evaluation, Medical Technologies
Topic Subcategory
Digital Health
Disease
Geriatrics, Injury & Trauma, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Surgery