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Trends in Utilization of Total Hip Arthroplasty for Femoral Neck Fractures in the United States

December 7, 2018 | Surgery
Spencer Summers, MD ; Luis Carlos Grau ; Dustin H. Massel, BS, Alvin Ong ; Fabio Orozco ; Samuel Rosas ; Victor Hernandez, MD MSc
Author and Disclosure Information

Dr. Summers is a resident in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Grau is a resident in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Mr. Massel is a medical student in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Ong is Assistant Professor in the Rothman Institute Department of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Orozco is Assistant Professor in the Rothman Institute Department of Orthopedics, Thomas Jefferson University, Philadelphia, Pennsylvania. Dr. Rosas is a research fellow in the Department of Orthopedic Surgery, University of Miami, Miami, Florida. Dr. Hernandez is Assistant Professor in the Department of Orthopedic Surgery, University of Miami, Miami, Florida.

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Address correspondence to: Victor Hugo Hernandez, MD, MS, Department of Orthopaedics and Rehabilitation, University of Miami, 1400 NW 12th Ave, Miami, FL 33136 (tel, 305-243-3000; fax: 305-689-4979; email, vhh1@med.miami.edu).

Am J Orthop. 2018;47(12). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.

Spencer Summers MD Luis Carlos Grau Dustin Massel BS Alvin Ong Fabio Orozco Samuel Rosas Victor Hernandez MD MSc . Trends in Utilization of Total Hip Arthroplasty for Femoral Neck Fractures in the United States. Am J Orthop. December 7, 2018

TAKE-HOME POINTS

  • The femoral neck patient population is older and has more medical comorbidities.
  • Hemiarthroplasty (HA) is being performed more commonly in patients > 50 years old for femoral neck fractures.
  • Open reduction and internal fixation is being performed more commonly in patients > 80 years old for femoral neck fractures.
  • The rate of adverse events following femoral neck fracture is higher in the total hip arthroplasty (THA) group than in the HA group.
  • THA is an independent risk factor for adverse events following femoral neck fracture.

Patients who underwent THA had the highest rate of any adverse event, LOS, and transfusion rate (Table 1 and Table 5).

The prevalence of postoperative pneumonia was highest in the HA group (3.4%), followed by the ORIF group (2.9%), and the THA group (2.6%) (P < .001, Table 5). There was also a significant difference in rates of intubation, pulmonary insufficiency, acute renal failure, pulmonary embolism, acute myocardial infarction, induced mental disorder, and deep venous thrombosis (P < .001 for all, Table 5).

SURGERY-RELATED ADVERSE EVENTS
Surgery-related outcomes over the entire study period were significantly different according to the type of procedure performed (P < .001, Table 5). Patients who underwent HA had the highest rate of acute postoperative anemia (20.2%), followed by those who underwent THA (19.7%), and ORIF (10.2%). Postoperative bleeding rates also varied significantly, with 1.2% in the HA group, followed by 1.0% in the ORIF group and 0.4% in the THA group (P < .001, Table 5). Acute postoperative infection rates also varied significantly, with the highest rate being observed in the HA group (0.6%) compared to that in the THA and ORIF groups (both 0.3%) (P < .001, Table 5).

Binomial Regression for Individual Risk Factors Associated with Mortality

Table 6, Table 7, and Table 8 detail the results of regression analyses in patients with femoral neck fractures for individual risk factors associated with mortality, any adverse event, and nonroutine discharge to a short- or long-term rehabilitation facility, respectively. Increasing age (50–64 years, OR: 0.238; 65–79 years, OR: 1.762; and ≥80 years, OR: 2.700), THA (OR: 1.743), and HA (OR: 2.574) were found to be independent risk factors for mortality in the perioperative period (P < .001 for each, Table 6). Increasing age (50–64 years, OR: 1.888; 65–79 years, OR: 2.983; and ≥80 years, OR: 3.722), THA (OR: 2.489), and HA (OR: 2.098) were also found to be independent risk factors for any adverse event in the perioperative period (P < .001, Table 7). Age (50–64 years, OR: 1.662; 65–79 years, OR: 4.320; and ≥80 years, OR: 7.102) was the best predictor for nonroutine discharge to a short- or long-term rehabilitation facility (P < .001, Table 8).

Binomial Regression for Individual Risk Factors Associated with Any Adverse Event

DISCUSSION                                                                                                            

Femoral neck fractures in the elderly population present a significant financial burden to the healthcare system.1-3,24,25 Consistent with previous epidemiological studies, our results show that the femoral neck fracture population has become older and has more medical comorbidities over the last 3 decades.27,28. Similarly, we also found that the rate of medical, surgical, and mechanical perioperative complications has increased in the same time period. Interestingly, the mortality rate has remained relatively similar.

Binomial Regression for Individual Risk Factors Associated with Any Non-routine (short or Long-term Rehabilitation Facility) Discharge

Continue to: Although patients undergoing HA...

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