title: Costs and Complications of Short Versus Long Cephalomedullary Nailing of OTA 31-A2 Proximal Femur Fractures in U.S. Veterans.
abstract: OBJECTIVE
  In fractures without subtrochanteric extension, the indications for the use of short versus long cephalomedullary nails (CMNs) for intertrochanteric femur fractures are unclear. We hypothesized that long nails would be associated with higher costs and similar complication rates.
  
  
  METHODS
  Retrospective comparative study.
  
  
  METHODS
  United States Department of Veterans Affairs Medical Centers.
  
  
  METHODS
  Patients receiving CMNs for OTA 31-A2 pertrochanteric fractures from 2001 to 2010.
  
  
  METHODS
  Short versus long cephalomedullary nailing.
  
  
  METHODS
  Costs, perioperative complications, readmissions, surgical failures, and mortality.
  
  
  RESULTS
  We identified 262 patients with OTA 31-A2 pertrochanteric fractures (125 treated with short CMNs and 137 treated with long CMNs). The 2 cohorts had similar demographic and medical characteristics. There were no significant differences in perioperative complications, readmissions within 30 days, surgical failures within one year, or death within 30 days or one year. The average cost of hospitalization was significantly higher for the cohort treated with long nails (greater than $7000 in actual costs, and greater than $3000 when statistically adjusted for differences in postoperative lengths of stay). Multivariable analyses showed no significant differences in the rates of development of at least one complication, readmission, or death.
  
  
  CONCLUSIONS
  In a cohort of patients with similar characteristics and fracture patterns, the use of long CMNs was associated with similar rates of complications, readmission, and reoperations, but significantly higher costs than with the use of short nails.
  
  
  METHODS
  Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: San Francisco Veterans Affairs Medical Center and the University of California, San Francisco, CA.
authors.forename: Henry
authors.initials: H
authors.lastname: Krigbaum
authors.forename: Steven
authors.initials: S
authors.lastname: Takemoto
authors.forename: Hubert T
authors.initials: HT
authors.lastname: Kim
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails / Q000145:classification / Q000191:economics* / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D005264:Femoral Fractures / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000191:economics / Q000295:instrumentation / Q000401:mortality; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics* / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*