Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2022; 13(8): 725-732
Published online Aug 18, 2022. doi: 10.5312/wjo.v13.i8.725
Higher cost of arthroplasty for hip fractures in patients transferred from outside hospitals vs primary emergency department presentation
Emanuel C Haug, Hakan Pehlivan, J Ryan Macdonell, Wendy Novicoff, James Browne, Thomas Brown, Quanjun Cui
Emanuel C Haug, Wendy Novicoff, James Browne, Thomas Brown, Quanjun Cui, Department of Orthopedic Surgery, University of Virginia, Charlottesville, VA 22908, United States
Hakan Pehlivan, Department of Orthopedic Surgery, Preferred Pediatric Orthopedic Surgery, Ridgewood, NJ 07450, United States
J Ryan Macdonell, Department of Orthopedic Surgery, Asheville Orthopedic Associates, Asheville, NC 28801, United States
Author contributions: Haug EC wrote and revised the manuscript and collected data; Pehlivan H and Macdonell JR contributed equally and helped design the study and collect data; Novicoff W did the statistical portion; Browne J, Brown T and Cui Q are the senior surgeons; and All authors contributed to this study equally.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the University of Virginia and was IRB exempt.
Conflict-of-interest statement: None of the authors have any conflicts of interests to report for this study.
Data sharing statement: Dataset available from the corresponding author at qc4q@hscmail.mcc.virginia.edu.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Quanjun Cui, MD, Professor, Department of Orthopedic Surgery, University of Virginia, 400 Ray C Hunt Drive, Charlottesville, VA 22908, United States. qc4q@hscmail.mcc.virginia.edu
Received: February 23, 2022
Peer-review started: February 23, 2022
First decision: April 13, 2022
Revised: April 23, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 18, 2022
Abstract
BACKGROUND

In 2016 Centers for Medicare and Medicaid Services proposed bundled payments for hip fractures to improve the quality and decrease costs of care. Patients transferred from other facilities may be imposing a financial risk on the hospitals that accept these patients.

AIM

To determine the costs associated with patients that either presented to the emergency department or were transferred from another hospital or skilled nursing facility (SNF) with the diagnosis of a hip fracture requiring operative intervention.

METHODS

A retrospective single institution review was conducted for all arthroplasty patients from 2010 to 2015. Inclusion criteria included a total or partial hip replacement for a hip fracture. Exclusion criteria included pathologic, periprosthetic, and fracture non-union. Data was collected to compare total observed costs for patients from the emergency department, patients from skilled nursing facilities, and patients from an outside hospital.

RESULTS

A total of 223 patients met the inclusion criteria. 135 (60.54%) of these patients presented primarily to the emergency department, 58 patients (26.01%) were transferred from an outside hospital, and 30 patients (13.43%) were transferred from a SNF. Cost data analysis showed that outside hospital patients demonstrated significantly greater total cost for their hospitalization ($43302) compared to emergency department patients ($28875, P = 0.000) and SNF patients ($28282, P = 0.000).

CONCLUSION

Patients transferred from an outside hospital incurred greater costs for their hospitalization than patients presenting from an emergency department or SNF. This is a strong argument for risk-adjustment models when bundling payments for the care of hip fracture patients.

Keywords: Total hip arthroplasty, Cost, Transfer, Outside hospital, Hip fracture

Core Tip: Transfers to regional tertiary care centers of critically ill and severely injured patients have been shown to decrease morbidity and mortality. Many of these patients have increased morbidity, length of stay, blood transfusion requirements, and intensive care utilization has been previously documented in transferred patients. To our knowledge, this study is the first to document this phenomenon in patients with femoral neck fractures being treated with arthroplasty. With the nationwide implementation of bundled payments looming, determining the additional risks and costs associated with providing referral services for community and regional hospitals is essential. It is clear from our data that patients transferred from an outside hospital more significantly strain the resources of the receiving tertiary care hospital compared to those patients who present primarily to the emergency department. This is a strong argument for robust risk-adjustment models that potentially even include patient point of origin.