title: Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture.
abstract: In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population.
  
  
  
  Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline. Continuous Medicare-only enrollment was required. Complications, resource use, and mortality from admission through 90 days following discharge (follow-up) were summarized.
  
  
  
  Four cohorts met selection criteria for analysis: (1) hemiarthroplasty diagnosis-related group (DRG) 469 (N = 19,634), (2) hemiarthroplasty DRG 470 (N = 77,744), (3) THA DRG 469 (N = 1686), and (4) THA DRG 470 (N = 9314). All-cause mortality during the study period was 51.6%, 29.5%, 48.1%, and 24.9% with mean 90-day costs of $28,952, $19,243, $29,763, and $18,561, respectively. Most of the patients waited 1 day from admission to surgery (41%-51%). Incidence of an all-cause complication was approximately 70% in each DRG 469 cohort and 14%-16% in each DRG 470 cohort.
  
  
  
  This study confirms patients with hip fracture are a costly subpopulation. Tailored care pathways to minimize post-acute care resource use are warranted for these patients.
authors.affiliation: Department of Medical Affairs, Medtronic Advanced Energy, Portsmouth, New Hampshire.
authors.forename: Christine I
authors.initials: CI
authors.lastname: Nichols
authors.affiliation: Department of Medical Affairs, Medtronic Advanced Energy, Portsmouth, New Hampshire.
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Vose
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Nunley
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery; D005102:Health Expenditures; D006295:Health Resources; D062785:Hemiarthroplasty; D006620:Hip Fractures / Q000601:surgery*; D025981:Hip Injuries / Q000601:surgery; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000191:economics; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D010384:Pelvic Bones / Q000601:surgery; D012189:Retrospective Studies; D019467:Subacute Care; D014481:United States
keywords: bundled payments; cost burden; hemiarthroplasty; hip fracture; total hip arthroplasty