TY - JOUR
T1 - Geriatric Distal Femur Fractures Treated with Distal Femoral Replacement Are Associated with Higher Rates of Readmissions and Complications
AU - Dekeyser, Graham J.
AU - Martin, Brook I.
AU - Marchand, Lucas S.
AU - Rothberg, David L.
AU - Higgins, Thomas F.
AU - Haller, Justin M.
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - Objective:Compare mortality and complications of distal femur fracture repair among elderly patients who receive operative fixation versus distal femur replacement (DFR).Design:Retrospective comparison.Setting:Medicare beneficiaries.Patients/Participants:Patients 65 years of age and older with distal femur fracture identified using Center for Medicare & Medicaid Services data from 2016 to 2019.Intervention:Operative fixation (open reduction with plating or intramedullary nail) or DFR.Main Outcome Measurements:Mortality, readmissions, perioperative complications, and 90-day cost were compared between groups using Mahalanobis nearest-neighbor matching to account for differences in age, sex, race, and the Charlson Comorbidity Index.Results:Most patients (90%, 28,251/31,380) received operative fixation. Patients in the fixation group were significantly older (81.1 vs. 80.4 years, P < 0.001), and there were more an open fractures (1.6% vs. 0.5%, P < 0.001). There were no differences in 90-day (difference: 1.2% [-0.5% to 3%], P = 0.16), 6-month (difference: 0.6% [-1.5% to 2.7%], P = 0.59), and 1-year mortality (difference:-3.3% [-2.9 to 2.3], P = 0.80). DFR had greater 90-day (difference: 5.4% [2.8%-8.1%], P < 0.001), 6-month (difference: 6.5% [3.1%-9.9%], P < 0.001), and 1-year readmission (difference: 5.5% [2.2-8.7], P = 0.001). DFR had significantly greater rates of infection, pulmonary embolism, deep vein thrombosis, and device-related complication within 1 year from surgery. DFR ($57,894) was significantly more expensive than operative fixation ($46,016; P < 0.001) during the total 90-day episode.Conclusions:Elderly patients with distal femur fracture have a 22.5% 1-year mortality rate. DFR was associated with significantly greater infection, device-related complication, pulmonary embolism, deep vein thrombosis, cost, and readmission within 90 days, 6 months, and 1 year of surgery.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
AB - Objective:Compare mortality and complications of distal femur fracture repair among elderly patients who receive operative fixation versus distal femur replacement (DFR).Design:Retrospective comparison.Setting:Medicare beneficiaries.Patients/Participants:Patients 65 years of age and older with distal femur fracture identified using Center for Medicare & Medicaid Services data from 2016 to 2019.Intervention:Operative fixation (open reduction with plating or intramedullary nail) or DFR.Main Outcome Measurements:Mortality, readmissions, perioperative complications, and 90-day cost were compared between groups using Mahalanobis nearest-neighbor matching to account for differences in age, sex, race, and the Charlson Comorbidity Index.Results:Most patients (90%, 28,251/31,380) received operative fixation. Patients in the fixation group were significantly older (81.1 vs. 80.4 years, P < 0.001), and there were more an open fractures (1.6% vs. 0.5%, P < 0.001). There were no differences in 90-day (difference: 1.2% [-0.5% to 3%], P = 0.16), 6-month (difference: 0.6% [-1.5% to 2.7%], P = 0.59), and 1-year mortality (difference:-3.3% [-2.9 to 2.3], P = 0.80). DFR had greater 90-day (difference: 5.4% [2.8%-8.1%], P < 0.001), 6-month (difference: 6.5% [3.1%-9.9%], P < 0.001), and 1-year readmission (difference: 5.5% [2.2-8.7], P = 0.001). DFR had significantly greater rates of infection, pulmonary embolism, deep vein thrombosis, and device-related complication within 1 year from surgery. DFR ($57,894) was significantly more expensive than operative fixation ($46,016; P < 0.001) during the total 90-day episode.Conclusions:Elderly patients with distal femur fracture have a 22.5% 1-year mortality rate. DFR was associated with significantly greater infection, device-related complication, pulmonary embolism, deep vein thrombosis, cost, and readmission within 90 days, 6 months, and 1 year of surgery.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
KW - DFR
KW - IMN
KW - ORIF
KW - femoral fracture
KW - fragility fracture
KW - geriatric fracture
UR - http://www.scopus.com/inward/record.url?scp=85171393850&partnerID=8YFLogxK
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U2 - 10.1097/BOT.0000000000002638
DO - 10.1097/BOT.0000000000002638
M3 - Article
C2 - 37296092
AN - SCOPUS:85171393850
SN - 0890-5339
VL - 37
SP - 485
EP - 491
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 10
ER -