Benjamin J Miller1, Xin Lu, Peter Cram. 1. Departments of Orthopaedics and Rehabilitation (B.J.M.) and Internal Medicine (X.L, P.C.), 200 Hawkins Drive, 01025 JPP, Iowa City, IA 52242. E-mail address for B.J. Miller: benjamin-j-miller@uiowa.edu.
Abstract
BACKGROUND: We examined trends in the treatment of femoral neck fractures over the last two decades. METHODS: We used Medicare Part A administrative data to identify patients hospitalized for closed femoral neck fracture from 1991 to 2008. We used codes from the International Classification of Diseases, Ninth Revision, to categorize treatment as nonoperative, internal fixation, hemiarthroplasty, and total hip arthroplasty. We examined differences in treatment according to hospital hip fracture volume, hospital location (rural or urban), and teaching status. RESULTS: Our sample consisted of 1,119,423 patients with intracapsular hip fractures occurring from 1991 to 2008. We found a generally stable trend over time in the percentage of patients managed with nonoperative treatment, internal fixation, hemiarthroplasty, and total hip arthroplasty. We found little difference in surgical treatment across different groups of hospitals (high volume compared with low volume, urban compared with rural, and teaching compared with nonteaching). The percentage of acute care hospitals treating hip fractures remained fairly constant (74.8% in 1991 to 1993 and 69.0% in 2006 to 2008). The median number of hip fractures treated per hospital did not change (thirty-three in 1991 to 1993 and thirty-three in 2006 to 2008). There was no increase in the percentage of fractures treated in high-volume hospitals over time (57.7% in 1991 to 1993 and 57.1% in 2006 to 2008) and little reduction in the percentage of fractures treated in low-volume hospitals (5.8% in 1991 to 1993 and 5.5% in 2006 to 2008). CONCLUSIONS: There has been little change in the trends of operative and nonoperative treatment for proximal femoral fractures over the last two decades, and there was little evidence of regionalization of hip fracture treatment to higher-volume hospitals.
BACKGROUND: We examined trends in the treatment of femoral neck fractures over the last two decades. METHODS: We used Medicare Part A administrative data to identify patients hospitalized for closed femoral neck fracture from 1991 to 2008. We used codes from the International Classification of Diseases, Ninth Revision, to categorize treatment as nonoperative, internal fixation, hemiarthroplasty, and total hip arthroplasty. We examined differences in treatment according to hospital hip fracture volume, hospital location (rural or urban), and teaching status. RESULTS: Our sample consisted of 1,119,423 patients with intracapsular hip fractures occurring from 1991 to 2008. We found a generally stable trend over time in the percentage of patients managed with nonoperative treatment, internal fixation, hemiarthroplasty, and total hip arthroplasty. We found little difference in surgical treatment across different groups of hospitals (high volume compared with low volume, urban compared with rural, and teaching compared with nonteaching). The percentage of acute care hospitals treating hip fractures remained fairly constant (74.8% in 1991 to 1993 and 69.0% in 2006 to 2008). The median number of hip fractures treated per hospital did not change (thirty-three in 1991 to 1993 and thirty-three in 2006 to 2008). There was no increase in the percentage of fractures treated in high-volume hospitals over time (57.7% in 1991 to 1993 and 57.1% in 2006 to 2008) and little reduction in the percentage of fractures treated in low-volume hospitals (5.8% in 1991 to 1993 and 5.5% in 2006 to 2008). CONCLUSIONS: There has been little change in the trends of operative and nonoperative treatment for proximal femoral fractures over the last two decades, and there was little evidence of regionalization of hip fracture treatment to higher-volume hospitals.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: Mohit Bhandari; P J Devereaux; Paul Tornetta; Marc F Swiontkowski; Daniel J Berry; George Haidukewych; Emil H Schemitsch; Beate P Hanson; Kenneth Koval; Douglas Dirschl; Pamela Leece; Marius Keel; Brad Petrisor; Martin Heetveld; Gordon H Guyatt Journal: J Bone Joint Surg Am Date: 2005-09 Impact factor: 5.284
Authors: Laura-Mae Baldwin; Yong Cai; Eric H Larson; Sharon A Dobie; George E Wright; David C Goodman; Barbara Matthews; L Gary Hart Journal: J Rural Health Date: 2008 Impact factor: 4.333
Authors: A Lopez-de-Andrés; R Jiménez-García; I Jiménez-Trujillo; V Hernández-Barrera; J M de Miguel-Yanes; M Méndez-Bailón; N Perez-Farinos; J de Miguel-Diez; M Á Salinero-Fort; P Carrasco-Garrido Journal: Osteoporos Int Date: 2015-08-29 Impact factor: 4.507
Authors: David Metcalfe; Ali Salim; Olubode Olufajo; Belinda Gabbe; Cheryl Zogg; Mitchel B Harris; Daniel C Perry; Matthew L Costa Journal: BMJ Open Date: 2016-04-07 Impact factor: 2.692
Authors: Robert Wilk; Michał Skrzypek; Małgorzata Kowalska; Damian Kusz; Bogdan Koczy; Piotr Zagórski; Wojciech Pluskiewicz Journal: Aging Clin Exp Res Date: 2017-03-28 Impact factor: 3.636