National trends in total hip arthroplasty for traumatic hip fractures:An analysis of a nationwide all-payer database  

作　　者：Anthony J Boniello Alexander M Lieber Kevin Denehy Priscilla Cavanaugh Yehuda E Kerbel Andrew Star 

机构地区：[1]Rothman Orthopaedic Institute,Thomas Jefferson University,Philadelphia,PA 19107,United States [2]Drexel University College of Medicine,Philadelphia,PA 19123,United States [3]Bluegrass Orthopaedics,Lexington,KY 40509,United States [4]Deparment of Orthopaedics,Hospital of University of Pennsylvania,Philadelphia,PA 19104,United States

出　　处：《World Journal of Orthopedics》2020年第1期18-26,共9页世界骨科杂志（英文版）

摘　　要：BACKGROUND Hemiarthroplasty(HA)has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures.Ideal treatment for younger,ambulatory patients is not as clear.Total hip arthroplasty(THA)has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIM To examine what patient characteristics are associated with undergoing THA or HA.To determine if outcomes differ between the groups.METHODS We queried the Nationwide Inpatient Sample(NIS)for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014.The NIS comprises a large representative sample of inpatient hospitalizations in the United States.International Classifications of Disease,Ninth Edition(ICD-9)codes were used to identify patients in our sample.Demographic variables,hospital characteristics,payer status,medical comorbidities and mortality rates were compared between the two procedures.Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTS Of the total 502060 patients who were treated for femoral neck fracture,51568(10.3%)underwent THA and the incidence of THA rose from 8.3%to 13.7%.Private insurance accounted for a higher percentage of THA than hemiarthroplasty.THA increased most in urban teaching hospitals relative to urban non-teaching hospitals.Mean length of stay(LOS)was longer for HA.The mean charges were less for HA,however charges decreased steadily for both groups.HA had a higher mortality rate,however,after adjusting for age and comorbidities HA was not an independent risk factor for mortality.Interestingly,private insurance was an independent predictor for treatment with THA.CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States,most notably in urban hospitals.HA and THA are decreasing in total charges and LOS.BACKGROUND Hemiarthroplasty(HA) has traditionally been the treatment of choice for elderly patients with displaced femoral neck fractures. Ideal treatment for younger,ambulatory patients is not as clear. Total hip arthroplasty(THA) has been increasingly utilized in this population however the factors associated with undergoing HA or THA have not been fully elucidated.AIM To examine what patient characteristics are associated with undergoing THA or HA. To determine if outcomes differ between the groups.METHODS We queried the Nationwide Inpatient Sample(NIS) for patients that underwent HA or THA for a femoral neck fracture between 2005 and 2014. The NIS comprises a large representative sample of inpatient hospitalizations in the United States. International Classifications of Disease, Ninth Edition(ICD-9)codes were used to identify patients in our sample. Demographic variables,hospital characteristics, payer status, medical comorbidities and mortality rates were compared between the two procedures. Multivariate logistic regression analysis was then performed to identify independent risk factors of treatment utilized.RESULTS Of the total 502060 patients who were treated for femoral neck fracture, 51568(10.3%) underwent THA and the incidence of THA rose from 8.3% to 13.7%.Private insurance accounted for a higher percentage of THA than hemiarthroplasty. THA increased most in urban teaching hospitals relative to urban non-teaching hospitals. Mean length of stay(LOS) was longer for HA. The mean charges were less for HA, however charges decreased steadily for both groups. HA had a higher mortality rate, however, after adjusting for age and comorbidities HA was not an independent risk factor for mortality. Interestingly,private insurance was an independent predictor for treatment with THA.CONLUSION There has been an increase in the use of THA for the treatment of femoral neck fractures in the United States, most notably in urban hospitals. HA and THA are decreasing in total charges and LOS.

关 键 词：Hip fracture Total hip arthroplasty HEMIARTHROPLASTY COST Length of stay National Inpatient Sample 

分 类 号：R68[医药卫生—骨科学]