OBJECTIVES : Despite the successful outcome of open reduction internal fixation (ORIF) for femur fractures, certain patients are susceptible to complications requiring post-surgical hardware removal. The purpose of this study was to evaluate the patient characteristics, complications, and healthcare resource utilization associated with hardware removal within 1-year after ORIF.

METHODS : This retrospective observational cohort study used IBM Marketscan Commercial and Medicare databases between 2010 and 2017. Patients ≥ 18 years old, diagnosed with femur fracture, and received ORIF (index) in an inpatient setting were identified. Patients were categorized into two groups based on post-surgical hardware removal identified over 1-year period after index discharge. Patient characteristics, complication rates including infections and nonunion, healthcare resource utilization in terms of all-cause readmission, emergency visits and all-cause costs were compared post-index discharge between patients with and without hardware removal.

RESULTS : A total of 27,090 patients with ORIF for femur fractures were identified. Over the 1-year period, 6.8% patients had hardware removed. Patients with hardware removal were younger (60 vs 72 years) had lower proportion of females (60.8% vs 68.0%), had osteoarthritis (12.9% vs 10.9%), were obese (4.5% vs 2.8%), and higher length of stay (6.3 vs 5.7 days) for the index-ORIF hospitalization (All p<0.05) as compared to those without hardware removal. Patients with hardware removal had statistically significantly higher rates of infection (22.03% vs 6.7%), non-union (41.5% vs 4.4%), readmissions (60.88% vs 27.1%) (All p<0.05) except emergency visits (42.2% vs 40.2%, p= 0.091). The mean all-cause costs post-index discharge was statistically significantly higher among the patients with hardware removal ($60,171 vs $31,185, p<0.05).

CONCLUSIONS : Certain patient characteristics are associated with increased risk for hardware removal after ORIF in femur fractures. Complication rates and healthcare resource utilization were significantly higher in patients requiring hardware removal after ORIF for femur fractures as compared to patients without hardware removal.