title: Cost Drivers After Surgical Management of Proximal Humerus Fractures in Medicare Patients.
abstract: OBJECTIVE
  This comparative effectiveness study sought to determine the impact of complications, readmission, and procedure choice on in-hospital and total 90-day costs for surgical management of proximal humerus fractures.
  
  
  METHODS
  Medicare claims data from the Upstate New York area (2008-2009) were evaluated. The study included all patients treated with open reduction and internal fixation (ORIF) or hemiarthroplasty for proximal humerus fracture identified by ICD-9 codes. The primary end points included in-hospital costs and total health care costs within 90 days after the index operation. Multivariable generalized linear models with negative binomial distributions and log link function were used for cost analysis.
  
  
  RESULTS
  ORIF was performed in 52 cases and hemiarthroplasty in 57 cases, total n = 109. On univariate analysis, readmission increased in-hospital cost by $54,345 and total 90-day costs by $63,104, whereas complications increased in-hospital cost by $23,300 and total 90-day costs by $30,237. On multivariable analysis, ORIF was associated with 29% lower in-hospital cost compared with hemiarthroplasty [Odds Ratio 0.71; 95% Confidence Interval (CI), 0.54-0.92; P = 0.01], and readmission was associated with a 5.68-fold in-hospital cost increase (Odds Ratio 5.68; CI, 3.57-9.03; P < 0.0001).
  
  
  CONCLUSIONS
  Complications and hospital readmission continue to drive cost upward underscoring the need for best practice. The acute inpatient period costs may be decreased with ORIF in appropriately selected patients with proximal humerus fractures in comparison with hemiarthroplasty. This study provides real world cost estimates with the cost implications of complications, readmissions, and procedure choice.
  
  
  METHODS
  Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopedic Surgery and†Surgical Health Outcomes & Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY.
authors.forename: Robert
authors.initials: R
authors.lastname: Thorsness
authors.forename: Edward
authors.initials: E
authors.lastname: Shields
authors.forename: James C
authors.initials: JC
authors.lastname: Iannuzzi
authors.forename: Linlin
authors.initials: L
authors.lastname: Zhang
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.forename: Ilya
authors.initials: I
authors.lastname: Voloshin
mesh_terms: D000368:Aged; D003198:Computer Simulation; D017281:Cost of Illness; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D062785:Hemiarthroplasty / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016344:Medicare Part A / Q000191:economics* / Q000706:statistics & numerical data; D018803:Models, Economic; D009518:New York / Q000453:epidemiology; D000070799:Open Fracture Reduction / Q000191:economics / Q000706:statistics & numerical data; D019637:Orthopedic Procedures / Q000191:economics* / Q000706:statistics & numerical data; D010359:Patient Readmission; D011183:Postoperative Complications / Q000191:economics* / Q000453:epidemiology; D015995:Prevalence; D012784:Shoulder Fractures / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D014481:United States