Variation in Revisions and Complications After Proximal Femoral Fracture Fixation—Association With Provider Characteristics
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 the rate of adverse outcomes after proximal femoral fracture (PFF) fixation, and their associations with provider characteristics.
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 revision after index surgery within 365-days post-index. Additional outcomes included mechanical complications and hip-related readmission within 90-days; malunion, and nonunion within 365-days. Generalized Linear Models with log link and binomial distribution were used to assess the relationship between provider characteristics (surgeon and hospital annual volume of PFF surgery, teaching status, rural/urban, and region) and outcomes, adjusted for patient demographics, clinical characteristics, fracture location and type.
RESULTS: Among 342,030 patients who underwent PFF surgery with IMN, revision rate was 0.8% at 30-days, 2.1% at 90-days and 5.9% at 365-days post-index. Total hip arthroplasty accounted for 45.7% of revisions within 365-days. Comparisons between surgeons with annual procedure volumes of 19+ cases (highest volume quartile) compared with <5 cases (lowest volume quartile) for 30-, 90- and 365-day revision were (odds ratio and confidence interval): 0.77 (0.68-0.88), 0.86 (0.79-0.93), 0.91 (0.86-0.97). Additionally, an annual volume of 19+ procedures was associated with lower rates of mechanical complications, hip related readmission, malunion and nonunion.
CONCLUSIONS: Lower surgeon volume was associated with higher rates of adverse outcomes after PFF surgery with IMN. In our study, nearly 80K (23%) patients were treated by surgeons with an annual volume < 5 and 250K (73%) with surgeons with an annual volume < 19. This presents an opportunity for emerging digital technologies to provide consistency and accuracy of IMN implantation, potentially improving patient outcomes.
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 revision after index surgery within 365-days post-index. Additional outcomes included mechanical complications and hip-related readmission within 90-days; malunion, and nonunion within 365-days. Generalized Linear Models with log link and binomial distribution were used to assess the relationship between provider characteristics (surgeon and hospital annual volume of PFF surgery, teaching status, rural/urban, and region) and outcomes, adjusted for patient demographics, clinical characteristics, fracture location and type.
RESULTS: Among 342,030 patients who underwent PFF surgery with IMN, revision rate was 0.8% at 30-days, 2.1% at 90-days and 5.9% at 365-days post-index. Total hip arthroplasty accounted for 45.7% of revisions within 365-days. Comparisons between surgeons with annual procedure volumes of 19+ cases (highest volume quartile) compared with <5 cases (lowest volume quartile) for 30-, 90- and 365-day revision were (odds ratio and confidence interval): 0.77 (0.68-0.88), 0.86 (0.79-0.93), 0.91 (0.86-0.97). Additionally, an annual volume of 19+ procedures was associated with lower rates of mechanical complications, hip related readmission, malunion and nonunion.
CONCLUSIONS: Lower surgeon volume was associated with higher rates of adverse outcomes after PFF surgery with IMN. In our study, nearly 80K (23%) patients were treated by surgeons with an annual volume < 5 and 250K (73%) with surgeons with an annual volume < 19. This presents an opportunity for emerging digital technologies to provide consistency and accuracy of IMN implantation, potentially improving patient outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
MT47
Topic
Clinical Outcomes, Health Service Delivery & Process of Care, Medical Technologies
Topic Subcategory
Digital Health
Disease
Geriatrics, Injury & Trauma, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Surgery