OBJECTIVES

: To characterize one-year healthcare resource utilization and costs for patients with pertrochanteric hip fractures who required open reduction, internal fixation with an intramedullary implant.

METHODS

: This retrospective observational cohort study used the Centers for Medicare and Medicaid (CMS) Standard Analytic File (5%) sample. Patients aged 65+ with a procedure code for intramedullary implant use (index) between 2013 and 2015 concurrent with a diagnosis of trochanteric hip fracture were identified. The outcomes of interest during one-year follow-up were length of stay (LOS) for index hospitalization, proportion of patients admitted to skilled nursing facility, home health agency, inpatient rehabilitation facility and other inpatient admissions. Additionally, the total all-cause payments across multiple settings were reported during one-year follow-up.

RESULTS

: A total of 6,423 patients were identified. The mean (SD) age of the cohort was 82.4 (7.8) years, 76.0% were female and 38.1% had a Charlson Comorbidity score ≥4. The mean (SD) LOS for index hospitalization was 5.1 (2.9) days. During the one-year follow-up from the index, 79.5% patients were admitted to a skilled nursing facility, 69.4% to a home health agency, 23.3% to an inpatient rehabilitation facility, and 37.3% to other acute inpatient admissions. Mean (SD) total all-cause payments from the index surgery through one-year follow-up were $58,315 ($31,889) and included payments from index hospitalization ($15,125), skilled nursing facility ($18,427), home health agency ($4,367), inpatient rehabilitation facility ($4,951), hospice ($1,383), long-term care ($415), other acute inpatient admissions ($6,089), outpatient hospital ($2,598), durable medical equipment ($222) and physician (professional) services ($4,739).

CONCLUSIONS

: Medicare patients who received intramedullary fixation for pertrochanteric hip fractures had high resource utilization and costs during one-year follow-up. The mean cost of care during the one-year follow-up was 3.9 times higher than index hospitalization costs for intramedullary fixation.