OBJECTIVES : To compare the medical resource utilization and costs among patients with early postoperative periprosthetic hip fractures (PPHFx) versus those without PPHFx after total hip arthroplasty (THA)

METHODS : This retrospective observational cohort study used health care claims from the United States Centers for Medicare and Medicaid Standard Analytic File (100%) sample. Patients aged 65+ with a claim for primary THA between 2010 and 2016 and a diagnosis of hip osteoarthritis (OA) were identified. Early postoperative PPHFx cohort included patients with diagnosis of postoperative PPHFx within 90 days of primary THA. The comparison cohort included patients without PPHFx anytime during the one-year follow-up period. A multilevel matching technique consisting of direct and propensity score matching was used to balance the patient, surgeon and hospital characteristics. The proportion of patients admitted at least once to skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), readmission, outpatient hospital during the 0-90 or 0-365 day period after THA was compared as well as the total all-cause payments during those periods.

RESULTS : A total of 2,658 patients (1,329 per cohort) were included after dual matching, mean age= 74.9 years and female= 74.4%. Utilization of any 90-day post-acute services was statistically significantly higher among patients in the early postoperative cohort versus those in the comparison cohort: SNF (64.5% vs 28.7%), IRF (22.6% vs 7.2%), readmissions (92.8% vs 8.8%) and outpatient hospital visit (78.9% vs 70.0%) (All p<0.0001). The mean 90-day total all-cause payments were also statistically significantly higher for patients in PPHFx cohort versus comparison ($53,669 vs $ 19,817, P<0.0001). All trends were similar in the 365-day follow-up.

CONCLUSIONS : Patients with early postoperative PPHFx had 2.7 times higher costs and statistically significantly higher utilization when compared to patients without PPHFx after THA. The differences observed during the 90-day follow-up were maintained over the one-year period as well.