title: Frequency and Treatment Trends for Periprosthetic Fractures About Total Hip Arthroplasty in the United States.
abstract: Periprosthetic hip fractures (PPHFx) are challenging complications that have become increasingly more prevalent. Wide variability exists in the quality and size of prior studies pertaining to hospital stay information. This study used the largest publicly available database in the United States to evaluate perioperative hospital data of PPHFx.
  
  
  
  The Healthcare Cost and Utilization Project-Nationwide Inpatient Sample was used to analyze trends related to the frequency, fracture type, mortality, treatment, patient demographics, time to surgery, length of stay (LOS), and hospital charges associated with PPHFx from 2006-2010.
  
  
  
  From 2006-2010, average patient age (76.7 years), hospital characteristics, rate of PPHFx, treatment choice, LOS (8.03 days), mortality (2.6%), disposition (78.1% to skilled nursing facility or inpatient rehab), and time to procedure (1.98 days) all remained relatively stable. The southern United States had the highest frequency of PPHFx and females had nearly twice the rate of PPHFx each year at an average of 67%. Despite these consistencies, hospital charges increased by an average of 8.3% per year over the study period ($27,683 over 5 years, P < .0001).
  
  
  
  In the era of containing cost while improving quality of care, this study demonstrates that despite consistent treatment trends of PPHFx, hospital charges are increasing independently. Regardless, surgeons can work to reduce LOS and charge to post acute care facilities to lessen spending. Refining our understanding of these relationships will be fundamental to further improving quality of care and cutting cost associated with these fractures.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon.
authors.forename: John S
authors.initials: JS
authors.lastname: Cox
authors.affiliation: Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Kowalik
authors.affiliation: Providence Health and Services, Portland, Oregon.
authors.forename: Hanne A
authors.initials: HA
authors.lastname: Gehling
authors.affiliation: Providence Health and Services, Portland, Oregon.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: DeHart
authors.affiliation: Orthopaedic Fracture Specialists, Portland, Oregon.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Duwelius
authors.affiliation: Summit Orthopaedics, Portland, Oregon.
authors.forename: Amer J
authors.initials: AJ
authors.lastname: Mirza
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006620:Hip Fractures; D017722:Hospital Charges; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D010351:Patient Discharge; D057068:Periprosthetic Fractures / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D014481:United States / Q000453:epidemiology
keywords: epidemiology; gender; hospital charges; in-hospital mortality; periprosthetic hip fracture; total hip arthroplasty