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Published on: July 2, 2021
Economic impact of periprosthetic hip fractures
D González-Martín1, J L Pais-Brito1, S González-Casamayor2
1Orthopedic Surgery and Traumatology Service, Hospital Universitario de Canarias, Tenerife, Spain; Universidad de La Laguna, Tenerife, Spain.
Insights
Periprosthetic hip fractures (PPHF) are costly, averaging €14,610.90 per patient. Revision surgery, extended hospital stays, and multiple operations significantly increase these costs, highlighting the need for optimized management protocols.
Area of Science:
- Orthopaedic Surgery
- Health Economics
- Trauma Management
Background:
- Hip replacement is a highly successful orthopaedic procedure.
- Periprosthetic hip fractures (PPHF) present significant patient morbidity and economic burden.
- Understanding the cost of PPHF is crucial for healthcare resource allocation.
Purpose of the Study:
- To conduct a detailed cost analysis of periprosthetic hip fractures (PPHF).
- To identify the primary cost drivers associated with PPHF management in a Spanish tertiary hospital.
Main Methods:
- Retrospective analysis of 78 patients diagnosed with PPHF between 2009 and 2019.
- Inclusion of costs related to hospital stay, operating theatre, implants, diagnostics, consultations, rehabilitation, and other surgical procedures.
- Categorization of surgical treatments into open reduction and internal fixation (ORIF) and revision surgery.
Main Results:
- The average cost per PPHF case was €14,610.90.
- Revision surgery, admissions exceeding 30 days, and multiple operations per admission were associated with significantly higher costs.
- Key cost components included hospital stay (46%), surgical procedures (35%), and implants (24%).
Conclusions:
- PPHF management incurs substantial healthcare costs, with revision surgery and prolonged hospitalizations being major contributors.
- Optimizing perioperative management protocols for PPHF is essential to mitigate morbidity and reduce associated economic impact.
- The findings underscore the need for evidence-based strategies to improve PPHF treatment efficiency and cost-effectiveness.
Introduction:
Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain.
Methods:
The study included all patients admitted between 2009 and 2019 with a diagnosis of «PPHF». We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission.
Results:
Seventy-eight patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). Sixty-nine patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1 139 650.17. The average cost was €14 610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%).
Conclusions:
Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14 610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.
