Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty For Hip Fracture

Abstract Background In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days post-discharge. While 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. Methods Using Medicare 100% Standard Analytic Files (2010–2014) we identified patients undergoing hemiarthroplasty or THA. Patients were aged 65+ with admitting diagnosis of closed hip fracture, with 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. Results Four cohorts met selection criteria for analysis: (1) hemiarthroplasty (Hemi) DRG 469 (N = 19,634), (2) Hemi DRG 470 (N = 77,744), (3) total hip arthroplasty (THA) DRG 469 (N = 1,686), and (4) THA DRG 470 (N = 9,314). 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. The majority waited one 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. Conclusion This study confirms patients with hip fracture are a costly sub-population. Tailored care pathways to minimize post-acute care resource use are warranted for these patients.