Fri., 10/15/10 Geriatrics, Paper #40, 10:06 am OTA-2010
Risk of Complications following Treatment of Intertrochanteric Hip Fractures with Intramedullary Nails and Plate Fixation inthe Medicare Population
Arthur L. Malkani, MD1; Colin Carroll1; Craig S. Roberts, MD, MBA1; David Seligson, MD1;
Edmund Lau, PhD2; Steven Kurtz, PhD2; Kevin Ong, PhD2;
1University of Louisville, Louisville, Kentucky, USA;
2Exponent Inc, Philadelphia, Pennsylvania, USA
Purpose: This study was designed to: (1) evaluate the temporal trends in treatment patterns for intertrochanteric hip fractures using intramedullary (IM) nails and plate fixation; (2) compare postoperative complication and mortality risk following IM nail and plate fixation; and (3) evaluate the risk factors for complications and mortality.
Methods: Intertrochanteric hip fracture patients were identified from the 5% nationwide sample of the Medicare claims data (1998-2007), using ICD-9-CM codes 820.2 and 820.3. Patients who underwent IM nail or plate fixation were identified using CPT codes 27245 and 27244, respectively. The cumulative incidence of deep venous thrombosis (DVT), infection, mechanical complications, neurologic complications, pulmonary embolism, and cardiac complications were computed for up to 90 days postsurgery, while mortality, malunion/ nonunion, conversion to hip replacement, and reoperation with a subsequent internal fixation were evaluated for up to 1 year postsurgery. Multivariate Cox regression (adjusted) was used to evaluate the risk factors for complications, which included age, gender, race, comorbidity (Charlson index), year of procedure, socioeconomic status, site of service (inpatient, outpatient), and type of procedure.
Results: 9,157 IM nail and 27,687 plate fixation procedures were identified. The proportion of intertrochanteric hip fractures treated with IM nailing increased from 3.3% to 63.1% between 1998 and 2007, compared with plate fixation. Based on 1998-2007 data, IM nail patients had a higher adjusted risk of pulmonary embolism at 90 days (+39%; P = 0.003) and mortality at 1 year (+9%; P < 0.001), compared with plate fixation patients. However, IM nail patients had a lower adjusted risk of conversion to hip replacement at 1 year (–22%; P = .054), which was also observed (–36%; P = 0.037) for the subgroup analysis (2006-2007 data). No other significant differences were found for the overall and subgroup analyses. Of the selected complications, DVT and death were the most frequently reported 90-day and 1-year complications (4% for DVT and 25% mortality in 2006-2007), respectively.
Conclusion: The changing treatment patterns for intertrochanteric hip fracture in the Medicare population from 1998-2007 agree with previous findings among younger orthopaedic surgeons. Our data suggest that there is limited improvement in outcomes, as measured by selected complications at 90 days and 1 year, for IM nail fixation compared with plate fixation. The IM group had a lower incidence of failure leading to total hip arthroplasty compared with the plate fixation group.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.