Similar THA results seen with arthroplasty surgeons vs other orthopedic subspecialists
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Study results show no difference in value of care or acute outcomes for patients with hip fractures who underwent total hip arthroplasty by a fellowship-trained adult reconstruction surgeon compared with other orthopedic subspecialists.
In a multicenter, retrospective cohort study, researchers from Duke University Hospital analyzed data for 291 patients with hip fractures who were treated at two centers with THA from June 2013 to February 2018. To assess the value of care for patients undergoing THA, researchers compared acute outcomes of 120 patients who underwent surgery performed by a fellowship-trained adult reconstruction surgeon and 171 patients who underwent surgery performed by a non-arthroplasty subspecialist.
According to the study, acute patient outcomes included OR time, length of stay (LOS), disposition to home vs. an inpatient facility and 90-day readmissions. Patient demographic data, as well as American Society of Anesthesiologists score, were also factored into the outcomes.
Investigators found no significant difference in any of the outcome variables between the two cohorts. Additionally, compared with other subspecialists, arthroplasty surgeons were not more likely to reduce 90-day readmissions and LOS or dispose a patient home, according to the study.
“In light of the high cost of care, CMS has chosen to include hip fractures as part of bundled initiatives in an effort to increase the value of care,” the researchers wrote in the study. “Rather than focusing on the availably of arthroplasty surgeons, hospitals should concentrate on expeditious surgical intervention and appropriate perioperative care for this vulnerable patient population,” as other orthopedic subspecialists can achieve comparable outcomes.
Perspective
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Jonathan Danoff, MD
It is well established that a patient sustaining a displaced femoral neck fracture and treated with a THA has an increased risk of postoperative complications and hospital readmission as compared with hip osteoarthritis. This can be associated with a significantly higher cost of care episode. In this multicenter study, the authors retrospectively reviewed a cohort of Medicare patients who sustained a femoral neck fracture and were treated with THA, comparing short-term outcomes between fellowship-trained arthroplasty surgeons with non-arthroplasty specialized orthopedic surgeons.
No significant difference was identified comparing operating time, length of stay, discharge disposition or 90-day readmission rates. No additional acute benefits were realized if the surgery was performed by an arthroplasty surgeon as part of a specialized hip fracture service to manage bundle care patients. The authors concluded that orthopedic surgeons, if well trained in hip fracture management and in THA, can achieve similar short-term outcomes to arthroplasty specialized surgeons. No evaluation was performed at midterm or long-term follow-up past 90-days.
As the prevalence of the bundled care reimbursement model increases, it is important to recognize potential areas of opportunity to decrease acute 90-day costs, while improving patient short and long-term outcomes by preoperatively medically optimizing patients and close post-discharge, post-acute care management of this patient population.
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