OBJECTIVES : Open reduction and internal fixation (ORIF) is used successfully in providing pain relief, anatomic reduction, and overall fracture stability for traumatic humerus fractures. In some cases of humeral fracture fixation, hardware removal is required. The purpose of this study was to evaluate the complications, healthcare resource utilization, and costs associated with hardware removal within 1 year after ORIF.

METHODS : A retrospective observational cohort study was designed using the IBM Marketscan Commercial and Medicare databases between 2010 and 2017. Participants ≥18 years, diagnosed with humerus fractures, and treated with ORIF (index) in an inpatient setting were identified. Inclusion required a continuous enrollment between 6-month pre-index and 1-year post-discharge from index hospitalization. Patients with polytrauma 6 months prior to index were excluded. Patients were divided into two groups based on post-surgical hardware removal identified over 1-year period after index discharge. Outcomes compared between patients with and without hardware removal were complication rates including infections and nonunion; healthcare resource utilization in terms of all-cause readmission and emergency visits; and all-cause costs of post-index discharge treatment.

RESULTS : A total of 6,413 patients with ORIF for humerus fractures were identified. The patients were mostly female (67.0%) with a mean (SD) age of 59.5 (19.8) years. Over the 1-year period, 12.3% had hardware removed. Patients with hardware removal had statistically significantly higher rates of infection (20.5% vs 4.3%), non-union (27.0% vs 8.7%), emergency visits (36.5% vs 29.5%) and readmission rates (40.0%vs 19.6%) (All p<0.0001). The mean (SD) all-cause costs post-index discharge was statistically significantly higher ($80,086 [$86,123] vs $51,880 [$69,962]) among the patients with hardware removal as compared to those without (p<0.0001).

CONCLUSIONS : Complication rates and healthcare resource utilization were significantly higher with 54% increased post-discharge costs in patients requiring hardware removal after ORIF for humerus fractures.