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Where Will Pathologic Hip Fractures Go in a Value-based Hip Fracture Bundle?

Azeem Tariq Malik1, John H Alexander, Safdar N Khan

  • 1From the Division of Musculoskeletal Oncology, Department of Orthopaedics, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH.

The Journal of the American Academy of Orthopaedic Surgeons
|February 4, 2020
PubMed

Insights

Patients with pathologic hip fractures face higher risks of complications, longer hospital stays, and increased mortality compared to native fractures. Bundled payment models need risk adjustment to ensure equitable care access for these vulnerable patients.

Area of Science:

  • Orthopedic Surgery
  • Health Services Research
  • Oncology

Background:

  • Bundled payment models are increasingly considered for hip fracture treatments.
  • Concerns exist regarding access to care for patients with complex fractures, like pathologic/neoplastic ones, within these payment structures.

Purpose of the Study:

  • To compare outcomes between native and pathologic/neoplastic hip fractures.
  • To assess the impact of fracture etiology on 30-day adverse events and resource utilization.

Main Methods:

  • Analysis of the 2011-2017 American College of Surgeons-National Surgical Quality Improvement Program database.
  • Inclusion of patients undergoing surgical fixation for hip fractures (hemiarthroplasty, pinning, ORIF, IM nailing).
  • Multivariate regression to compare outcomes including complications, readmissions, mortality, and length of stay.

Main Results:

  • Pathologic/neoplastic hip fractures (0.6% of cohort) showed significantly higher odds of prolonged length of stay (OR 1.57).
  • Increased odds of pulmonary embolism (OR 3.67), deep vein thrombosis (OR 2.03), 30-day readmissions (OR 1.43), and 30-day mortality (OR 2.66) were observed.

Conclusions:

  • Pathologic/neoplastic hip fractures are associated with a worse adverse event profile.
  • Risk adjustment in bundled payments is crucial for fair reimbursement and maintaining access to care for patients with these complex fractures.
Abstract

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