Haug EC, Pehlivan H, Macdonell JR, Novicoff W, Browne J, Brown T, Cui Q. Higher cost of arthroplasty for hip fractures in patients transferred from outside hospitals vs primary emergency department presentation. World J Orthop 2022; 13(8): 725-732 [PMID: 36159622 DOI: 10.5312/wjo.v13.i8.725]
Corresponding Author of This Article
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
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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.
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 Processing time: 174 Days and 9.2 Hours
Core Tip
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.
