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Geriatric Distal Femur Fractures Treated with Distal Femoral Replacement Are Associated with Higher Rates of Readmissions and Complications.
Journal of Orthopaedic Trauma 2023 May 30
OBJECTIVE: Compare mortality and complications of distal femur fracture repair among elderly patients who receive operative fixation versus distal femoral replacement (DFR).
DESIGN: Retrospective comparison.
SETTING: Medicare beneficiariesPatients/Participants: Distal femur fracture patients 65 years of age and older identified using Center for Medicare & Medicaid Services (CMS) data from 2016-2019.
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 (CCI).
RESULTS: Most patients (90%, 28,251/31,380) received operative fixation. Patients in the fixation group were significantly older (81.1 years 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% [-.5%;3%], p=0.16), 6 month (difference: 0.6% [-1.5%;2.7%], p=0.59), and 1 year mortality (difference: -3.3% [-2.9; 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 infection, PE, DVT, 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 distal femur fracture patients have a 22.5% one-year mortality rate. DFR was associated with significantly greater infection, device-related complication, PE, DVT, 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.
DESIGN: Retrospective comparison.
SETTING: Medicare beneficiariesPatients/Participants: Distal femur fracture patients 65 years of age and older identified using Center for Medicare & Medicaid Services (CMS) data from 2016-2019.
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 (CCI).
RESULTS: Most patients (90%, 28,251/31,380) received operative fixation. Patients in the fixation group were significantly older (81.1 years 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% [-.5%;3%], p=0.16), 6 month (difference: 0.6% [-1.5%;2.7%], p=0.59), and 1 year mortality (difference: -3.3% [-2.9; 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 infection, PE, DVT, 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 distal femur fracture patients have a 22.5% one-year mortality rate. DFR was associated with significantly greater infection, device-related complication, PE, DVT, 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.
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