Predictors of In-Hospital Mortality, Cost, and Length of Stay following Periprosthetic Fracture of the Hip
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Published on: September 7, 2022
Ramón A Arza1, Ajay S Potluri1, Mitchell Thom2
1Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Insights
Predictors of in-hospital mortality, length of stay, and costs for periprosthetic hip fractures (PPHFx) after total hip arthroplasty (THA) were identified. Higher comorbidity and advanced age were linked to mortality, while race and hospital type influenced costs and length of stay.
Area of Science:
- Orthopedic Surgery
- Health Services Research
- Geriatric Medicine
Background:
- Total hip arthroplasty (THA) is increasingly common.
- Periprosthetic hip fractures (PPHFx) following THA carry significant morbidity and economic burden.
- Identifying predictors for PPHFx outcomes is crucial for patient management and resource allocation.
Purpose of the Study:
- To identify predictors of in-hospital mortality.
- To identify predictors of length of stay (LOS).
- To identify predictors of hospital costs associated with PPHFx.
Main Methods:
- Retrospective analysis of the National Inpatient Sample (NIS) database from 2016-2019.
- Inclusion of patients diagnosed with periprosthetic fractures around hip prostheses (ICD-10-CM codes M97.01XA, M97.02XA).
- Univariable and multivariable logistic and linear regression analyses were used to assess predictors of mortality, LOS, and costs.
Main Results:
- Significant predictors of in-hospital mortality included advanced age, female sex, and comorbidities like metastatic cancer and liver disease.
- Increased LOS was associated with black race, comorbidities (paralysis, fluid/electrolyte disorders), payment source, income, hospital size, and type.
- Hospital costs were associated with race, comorbidities, hospital type, and the specific procedure performed.
Conclusions:
- Higher comorbidity burden (fluid/electrolyte disorders, paralysis, metastatic cancer) is linked to mortality, LOS, and costs in PPHFx.
- Advanced age, especially in nonagenarians, predicts in-hospital mortality.
- Procedure type is a primary driver of hospital costs for PPHFx.
Purpose:
The frequency of total hip arthroplasty (THA) has increased significantly. The morbidity and economic burden of periprosthetic hip fractures (PPHFx) following THA is high. The objective of this study is to identify predictors of in-hospital mortality, length of stay (LOS), and hospital costs associated with PPHFx.
Materials And Methods:
A retrospective analysis of the National Inpatient Sample (NIS) for all patients diagnosed with periprosthetic fracture around the internal prosthetic hip joint (International Classification of Disease, Tenth Revision, Clinical Modification [ICD-10-CM], M97.01XA, and M97.02XA) between 2016 and 2019 was conducted. Predictors of outcomes following PPHFx were assessed using univariable analyses; those with a P-value below 0.2 were included in the final multivariable models. Logistic regression was used to determine predictors of in-hospital mortality and linear regression for assessment of hospital cost and LOS predictors.
Results:
The study included 77,565 patient encounters. Significant predictors of in-hospital mortality included age, female sex, and comorbidities, such as metastatic cancer and liver disease. Predictors of increased LOS included black race, comorbidities, such as paralysis and fluid and electrolyte disorders, primary payment source, household income, hospital size, and type. Hospital costs showed an association with race, comorbidities, hospital type, and procedure.
Conclusion:
In the setting of PPHFx, higher comorbidity, particularly fluid and electrolyte, paralysis, and metastatic cancer, showed an association with all three outcome variables. In addition to comorbidity, advanced age, particularly nonagenarians, showed an association with in-hospital mortality, while cost was primarily driven by the procedure performed.