Ninety-Day Mortality After Intertrochanteric Hip Fracture: Does Provider Volume Matter?

Forte, Mary L.; Virnig, Beth A.; Swiontkowski, Marc F.; Bhandari, Mohit; Feldman, Roger; Eberly, Lynn E.; Kane, Robert L.
April 2010
Journal of Bone & Joint Surgery, American Volume;Apr2010, Vol. 92-A Issue 4, p799
Academic Journal
Background: Research on the relationship between orthopaedic volume and outcomes has focused almost exclusively on elective arthroplasty procedures. Geriatric patients who have sustained an intertrochanteric hip fracture are older and have a heavier comorbidity burden in comparison with patients undergoing elective arthroplasty; therefore, any advantage of provider volume in terms of mortality could be overwhelmed by the severity of the hip fracture condition itself. This study examined the association between surgeon and hospital volumes of procedures performed for the treatment of intertrochanteric hip fractures in Medicare beneficiaries and inpatient through ninety-day postoperative mortality. Methods: The Medicare 100% files of hospital and physician claims plus the beneficiary enrollment files for 2000 through 2002 identified beneficiaries who were sixty-five years of age or older and who underwent inpatient surgery for the treatment of an intertrochanteric hip fracture with internal fixation. Provider volumes of intertrochanteric hip fracture cases were calculated with use of unique surgeon and hospital provider numbers in the claims. Fixed effects regression analysis using generalized estimating equations was used to model the association between hospital and surgeon intertrochanteric hip fracture volume and inpatient through ninety-day mortality, controlling for age, sex, race, Charison comorbidity score, subtrochanteric fracture, prefracture nursing home residence, Medicaid-administered assistance, surgical device, and year. The unadjusted inpatient, thirty, sixty, and ninety-day mortality rates and adjusted relative risks are reported. Results: Between March 1, 2000, and December 31, 2002, 192,365 claims met inclusion criteria and matched with provider information. The unadjusted inpatient, thirty-day, sixty-day, and ninety-day mortality rates were 2.91%, 7.92%, 12.34%, and 15.19%, respectively. Patients managed at lower-volume hospitals had significantly higher (10% to 20%) adjusted risks of inpatient mortality than those managed at the highest-volume hospitals. By sixty days postoperatively, the increased mortality risk persisted only among patients managed at the lowest-volume hospitals (six cases per year or fewer). Patients who were managed by surgeons who treated an average of two or three cases per year had the highest mortality risks when compared with patients managed by the highest-volume surgeons. Conclusions: Only the highest-volume hospitals showed an inpatient mortality benefit for Medicare patients with intertrochanteric hip fractures. Unlike the situation with elective arthroplasty procedures, our findings do not indicate a need to direct patients with routine hip fractures exclusively to high-volume centers, although the higher mortality rates found in the lowest-volume hospitals warrant further investigation.


Related Articles

  • Treatment of intertrochanteric hip fractures with the AO trochanteric fixation nail. Gardner, Michael J.; Bhandari, Mohit; Lawrence, Brandon D.; Helfet, David L.; Lorich, Dean G. // Orthopedics;Feb2005, Vol. 28 Issue 2, p117 

    Further biomechanical and clinical studies are necessary to validate the efficacy of the Trochanteric Fixation Nail, but in our experience this is an improvement over the currently available devices.

  • 50 Years Ago in CORR: A New Method of Pelvic Fixation William Johnson MD Clin Orthop. 1958;11:194-201. Brand, Richard // Clinical Orthopaedics & Related Research;Aug2012, Vol. 470 Issue 8, p2333 

    In this article, the author discusses a method used for fixing pelvic factures with help of pelvic fixator devices described by orthopaedic surgeon William Johnson in an article published in a 1958 issue of the periodical. It informs that flexible system of fixation devices helps in relocating...

  • Percutaneous reduction and low-profile plating are keys for limited incision calcaneus fracture fixation. Hsu, Andrew R.; Cohen, Bruce E. // Orthopedics Today;Jun2015, Vol. 35 Issue 6, p4 

    No abstract available.

  • Diamond blades can be beneficial for high-volume surgeons. Yen, Michael T.; Flaharty, Patrick M.; Anderson, Richard L. // Ophthalmology Times;4/1/2002, Vol. 27 Issue 7, p42 

    Reports on the use of CVD diamond scalpels to intraocular surgeons. Examples of incisional instruments; Description of the scalpels; Benefits; Theoretical benefits.

  • Use of leg positioning holders. Richardson, Caroline // British Journal of Perioperative Nursing;Mar2004, Vol. 14 Issue 3, p127 

    Provides information about Direct Placement Leg Holders, used in lower limb internal fixation for fractures. Brief history of how and why their potential use in orthopedic trauma; Benefits for patient care and how they can improve patient positioning; Benefits for practitioners acting as...

  • Fractures of the lower extremity lead to lower survivorship in elderly. Press, Robert // Orthopedics Today;Dec2010, Vol. 30 Issue 12, p48 

    The article reports on a study presented at the 2010 Annual Meeting of the Orthopaedic Trauma Association in Baltimore, Maryland which showed the usefulness of the age-adjusted Charlson Comorbidity Index in predicting survival after distal femur fractures in older patients.

  • A new technique of fixation of radial head fractures using a modified tubular plate. Guha, A.R.; Jago, E.R. // Journal of Postgraduate Medicine;Apr-Jun2004, Vol. 50 Issue 2, p113 

    Radial head fractures are fairly common, occurring in 17-44% of all elbow injuries. Mason Type 2 fractures may be fixed using mini fragment screws, this fixation often needing augmentation with a plate to make the construct rotationally stable. However, the drill holes needed to fix the plate to...

  • New orthopedic device designed to be 'steerable.'.  // Medical Device Daily;7/30/2009, Vol. 13 Issue 145, p1 

    The article deals with ArthroSteer, the steerable orthopedic device launched by OrthoDynamix. The device can be used in managing joint pain caused by sports injuries, genetic damage and pre-arthritis. It describes the impact of the device on arthroscopic procedures. It discusses the benefits of...

  • The immediate effect of navigation on implant accuracy in primary mini-invasive unicompartmental knee arthroplasty. Rosenberger, Ralf; Fink, Christian; Quirbach, Sebastian; Attal, Rene; Tecklenburg, Katja; Hoser, Christian // Knee Surgery, Sports Traumatology, Arthroscopy;Dec2008, Vol. 16 Issue 12, p1133 

    The success of unicompartmental knee arthroplasty (UKA) is highly dependent on the accuracy of the component alignment. Objective of the present study was to evaluate the immediate effect of image-free computer navigation technology on implant accuracy in primary mini-invasive UKA. This study...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics