Stable intertrochanteric hip fracture fixation: Device choice does not impact cost of care
Ryan D. DeAngelis, Nicole A. Zelenski, John Logan Brock, Ryan S. Charette, Alexander L. Neuwirth, Samir MehtaIntroduction
There are over 300,000 hip fractures in the U.S. annually. Hip fractures create a substantial health and economic burden, with one-year mortality after a hip fracture approaching 30% and hip fractures creating healthcare costs of over $12 billion annually. Stable intertrochanteric hip fractures can be treated with either an extramedullary implant (sliding hip screw, SHS) or an intramedullary nail (IMN), which has a higher hardware cost. This study compared the cost of care between patients treated with IMN versus SHS after stable intertrochanteric hip fracture.
Methods
This was a retrospective cohort study of patients over age 55 with stable intertrochanteric hip fractures at a Level 1 trauma center over a 4-year period. We collected demographic information, fixation method, outcomes measures, and cost data. Statistical analysis compared patient characteristics, costs, and outcomes between SHS and IMN patients.
Results
83 patients were included, of whom 57 received an SHS and 26 received an IMN. There were no differences in age, gender, BMI, and ASA score between patients who received SHS vs. IMN (p>0.05 for all). There were no significant differences in mortality or readmission rates. SHS and IMN patients had no significant differences in length of stay (8.3 +/- 5.2 vs 8.0 +/- 3.5 days, p=0.76), direct costs ($22,324 +/- $10,603 vs $19,881 +/- $5,894, p=0.18), or health system profit (-$1,313 +/- $8,559 vs -$4,373 +/- $8,394, p=0.13).
Discussion
We compared the cost of care between patients treated with IMN versus SHS after stable intertrochanteric hip fracture. The use of IMN for the treatment of stable intertrochanteric hip fractures is controversial due to the significant cost of the implant. We found no differences in length of stay or care costs between patients treated with IMN versus SHS. Differences in implant cost were insignificant compared to the total cost of care.