Trend and Economic Implications of Implant Selection in the Treatment of Intertrochanteric Hip Fractures: A Review of the American Board of Orthopaedic Surgery Database From 2007 to 2017

Lauren Smith, Melissa S Albersheim, Breanna L. Blaschke, Harsh R Parikh, David A Solfelt, Ann E. Van Heest, Brian P Cunningham

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

INTRODUCTION: Intertrochanteric (IT) fractures are estimated to burden the healthcare system six billion dollars annually. Previous studies have documented a trend of early-career orthopaedic surgeons favoring intramedullary nails (IMNs) for these fractures, despite multiple randomized controlled trials demonstrating no evidence for improved patient outcomes when compared with sliding hip screws (SHSs). The purpose of this study was to report the trend of implant utilization for IT fracture fixation from 2007 to 2017.

METHODS: The American Board of Orthopaedic Surgery (ABOS) Part II (oral) database was used to identify IT fractures (International Classification of Diseases, 9th revision, code 820.21 or 820.31, and 10th revision, code S72.14) over a 10-year period (2007 to 2017). The cases were categorized by IMN or SHS fixation by surgeon-reported Current Procedural Terminology codes. Utilization of the devices was analyzed according to year, and the implants were compared for outcomes, complications, and cost.

RESULTS: As of 2017, 92.4% of IT fractures were being fixed through IMN, representing a 49.1% increase in the number of IMN devices used during the course of this study. SHS had significantly lower medical complication rate (21.3%) and readmittance rate (4.0%) compared with the IMN (medical complication: 26.9%; P < 0.01) (readmittance rate: 5.4%; P = 0.02). SHS also had significantly lower rates of anemia (5.2%) and patient expiration (4.8%) compared with IMN (anemia: 10.2%; P < 0.01) (patient expiration: 6.1%; P = 0.01). Overall surgical complication rates, reoperative rates, and anesthetic complications did not differ between constructs. A cost differential of $671,812 was found from the 2007-projected distribution, which rose to $3,911,211.00 across the entire 11-year duration of the study for the population.

DISCUSSION: Early-career orthopaedic surgeons continue to use a more expensive implant for IT fractures despite limited evidence for improved outcomes.

LEVEL OF EVIDENCE: Level III; Retrospective Cohort Study.

Original languageEnglish (US)
Pages (from-to)789-795
Number of pages7
JournalThe Journal of the American Academy of Orthopaedic Surgeons
Volume29
Issue number18
DOIs
StatePublished - Sep 15 2021

Bibliographical note

Publisher Copyright:
Copyright © 2021 by the American Academy of Orthopaedic Surgeons.

Keywords

  • Bone Nails
  • Bone Screws
  • Fracture Fixation, Internal
  • Fracture Fixation, Intramedullary/adverse effects
  • Hip Fractures/surgery
  • Humans
  • Retrospective Studies
  • United States/epidemiology

PubMed: MeSH publication types

  • Review
  • Journal Article

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