OBJECTIVES : This study evaluated the frequency of reoperation within one-year of initial intramedullary fixation for patients with pertrochanteric hip fracture and compared one-year healthcare resource utilization (HRU) and cost burden for patients with and without reoperation.

METHODS : This is a retrospective evaluation of medical claims from the United States Centers for Medicare and Medicaid Standard Analytic File (5%) sample. Patients aged ≥65 years who underwent fixation with an intramedullary implant for a pertrochanteric fracture between 2013-2015 were included. Healthcare resources that were evaluated included skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), readmissions, and outpatient hospital visits. All-cause payments for these services comprised overall cost burden. Generalized Linear Models were used to evaluate HRU and cost burden over one-year post-surgery and to adjust for confounding between patients with and without a reoperation.

RESULTS : A total of 6,423 Medicare patients were included in the analysis. Mean (SD) age was 82.4 (7.8) years, 76.0% were female, and 93.3% were white. A second hip surgery within one year after the index fixation procedure was performed in 414 patients (6.4%): 121 (29.2%) contralateral, 115 (27.8%) ipsilateral and 178 (43.0%) without specified laterality. After adjusting for confounding factors, Medicare patients with ipsilateral reoperations had statistically significantly higher readmissions (100% vs 32.5%, p<0.0001), outpatient hospital visits (96.4% vs 88.8%, p=0.018), admissions to a SNF (88.5% vs 80.4%, p=0.024), and admissions to an IRF (38.8% vs 22.0%, p<0.0001) compared to patients without reoperations. The adjusted mean total all-cause payments ($90,162 vs $55,131, p<0.0001) during the one-year follow-up were statistically significantly higher among patients with reoperations as compared to patients without reoperations.

CONCLUSIONS : Patients who require a second hip surgery after initial fixation with an intramedullary implant for pertrochanteric hip fractures have significantly higher one-year HRU and 63.5% higher costs than patients without reoperation.