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Factors associated with primary hip arthroplasty after hip fracture
Ishveen Chopra1, Kahlid M Kamal, Jayashri Sankaranarayanan
1Division of Clinical, Social and Administrative Sciences, Mylan School of Pharmacy, 418F Mellon Hall, Duquesne University, 600 Forbes Ave, Pittsburgh, PA 15282, USA. choprai@duq.edu
Objectives:
To determine patient, clinical, and hospital factors associated with receiving total hip arthroplasty (THA) and hemiarthroplasty (HA) in the United States.
Study Design:
Retrospective, cross-sectional study.
Methods:
Hospital discharge records with a principal diagnosis of hip fracture and primary hip arthroplasty or no surgery were identified from the 2009 Nationwide Inpatient Sample data set of the Healthcare Cost and Utilization Project. Patient (age, sex, race, income, payer), clinical (comorbidities, severity, fracture type), hospital (region, location, teaching status, bed size, ownership), and outcome (receipt of THA or HA) variables were extracted and weighted for the analyses. Univariate and multivariate analysis were conducted and significance was set at P < .05.
Results:
A total of 92,861, 15,489, and 9863 discharges occurred for HA, no surgery, and THA, respectively. Compared with no surgery, THA or HA was significantly more likely in patients who were aged > 50 years, white, and female; had > $39,000 income; lived in a medium-metro or noncore county; had comorbidities (anemia, hypertension); and had intracapsular fracture. THA or HA was significantly more likely in urban, privately owned hospitals with > 249 beds. Compared with no surgery, THA was significantly more likely in nonteaching hospitals, the Northeast region, and in private insurance or self-pay patients with moderate to severe fractures; HA was more likely in teaching hospitals, in the South and West, and in Medicare patients with minor fractures.
Conclusions:
Similarities and differences in patient, clinical, and hospital factors associated with surgical treatments of hip fracture warrant the attention of providers and payers.