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

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.