Hip & pelvis

  • 제36권2호
  • /
  • Pages.144-154
  • /
  • 2024
  • /
  • 2287-3260(pISSN)
  • /
  • 2287-3279(eISSN)
대한고관절학회 (The Korean Hip Society)
권호 표지
DOI QR코드

DOI QR Code

Comparative Interrupted Time Series Analysis of Medical Expenses in Patients with Intertrochanteric Fracture Who Underwent Internal Fixation and Hemiarthroplasty

  • Seung-Hoon Kim (Department of Preventive Medicine, Eulji University College of Medicine) ;
  • Yonghan Cha (Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine) ;
  • Suk-Yong Jang (Department of Healthcare Management, Graduate School of Public Health, Yonsei University) ;
  • Bo-Yeon Kim (Healthcare Review and Assessment Committee, Health Insurance Review & Assessment Service) ;
  • Hyo-Jung Lee (Quality Assessment Department, Health Insurance Review & Assessment Service) ;
  • Gui-Ok Kim (Quality Assessment Department, Health Insurance Review & Assessment Service)
  • 투고 : 2023.09.22
  • 심사 : 2023.11.12
  • 발행 : 2024.06.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: The objective of this study was to assess postoperative direct medical expenses and medical utilization of elderly patients who underwent either hemiarthroplasty (HA) or internal fixation (IF) for treatment of a femoral intertrochanteric fracture and to analyze differences according to surgical methods and age groups. Materials and Methods: Data from the 2011 to 2018 Korean National Health Insurance Review & Assessment Service database were used. Risk-set matching was performed for selection of controls representing patients with the same sex, age, and year of surgery. A comparative interrupted time series analysis was performed for evaluation of differences in medical expenses and utilization between the two groups. Results: A total of 10,405 patients who underwent IF surgery and 10,405 control patients who underwent HA surgery were included. Medical expenses were 18% lower in the IF group compared to the HA group during the first year after the fracture (difference-in-difference [DID] estimate ratio 0.82, 95% confidence interval [CI] 0.77-0.87, P<0.001), and 9% lower in the second year (DID estimate ratio 0.91, 95% CI 0.85-0.99, P=0.018). Length of hospital stay was significantly shorter in the IF group compared to the HA group during the first two years after time zero in the age ≥80 group. Conclusion: A noticeable increase in medical expenses was observed for patients who underwent HA for treatment of intertrochanteric fractures compared to those who underwent IF over a two-year period after surgery. Therefore, consideration of such findings is critical when designing healthcare policy support for management of intertrochanteric fractures.

키워드

과제정보

This study was conducted as a Joint Project on Quality Assessment Research by the Health Insurance Review & Assessment Service (HIRA). This study was based on data from the HIRA (research data No. M20220219833). The results of the study are not related to the National Health Insurance Service.

참고문헌

  1. Cha YH, Ha YC, Yoo JI, Min YS, Lee YK, Koo KH. Effect of causes of surgical delay on early and late mortality in patients with proximal hip fracture. Arch Orthop Trauma Surg. 2017;137:625-30. https://doi.org/10.1007/s00402-017-2674-2
  2. Egol KA, Marcano AI, Lewis L, Tejwani NC, McLaurin TM, Davidovitch RI. Can the use of an evidence-based algorithm for the treatment of intertrochanteric fractures of the hip maintain quality at a reduced cost? Bone Joint J. 2014;96-B:1192-7. https://doi.org/10.1302/0301-620X.96B9.34153
  3. Cha YH, Ha YC, Lim JY. Establishment of fracture liaison service in Korea: where is it stand and where is it going? J Bone Metab. 2019;26:207-11. https://doi.org/10.11005/jbm.2019.26.4.207
  4. Chevalley T, Hoffmeyer P, Bonjour JP, Rizzoli R. An osteoporosis clinical pathway for the medical management of patients with low-trauma fracture. Osteoporos Int. 2002;13:450-5. https://doi.org/10.1007/s001980200053
  5. Choi JH, Kim BR, Nam KW, et al. Effectiveness of a homebased fragility fracture integrated rehabilitation management (FIRM) program in patients surgically treated for hip fractures. J Clin Med. 2020;10:18. https://doi.org/10.3390/jcm10010018
  6. Swart E, Makhni EC, Macaulay W, Rosenwasser MP, Bozic KJ. Cost-effectiveness analysis of fixation options for intertrochanteric hip fractures. J Bone Joint Surg Am. 2014;96:1612-20. https://doi.org/10.2106/JBJS.M.00603
  7. Temiz A, Durak A, Atici T. Unstable intertrochanteric femur fractures in geriatric patients treated with the DLT trochanteric nail. Injury. 2015;46 Suppl 2:S41-6. https://doi.org/10.1016/j.injury.2015.05.031
  8. Kregor PJ, Obremskey WT, Kreder HJ, Swiontkowski MF. Unstable pertrochanteric femoral fractures. J Orthop Trauma. 2014;28 Suppl 8:S25-8. https://doi.org/10.1097/BOT.0000000000000187
  9. Hongku N, Woratanarat P, Nitiwarangkul L, Rattanasiri S, Thakkinstian A. Fracture fixation versus hemiarthroplasty for unstable intertrochanteric fractures in elderly patients: a systematic review and network meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res. 2022;108:102838. https://doi.org/10.1016/j.otsr.2021.102838
  10. Yoo JI, Ha YC, Lim JY, Kang H, Yoon BH, Kim H. Early rehabilitation in elderly after arthroplasty versus internal fixation for unstable intertrochanteric fractures of femur: systematic review and meta-analysis. J Korean Med Sci. 2017;32:858-67. https://doi.org/10.3346/jkms.2017.32.5.858
  11. Health Insurance Review & Assessment Service (HIRA). HIRA Bigdata portal [Internet]. Wonju: HIRA [cited 2021 Dec 17]. Available from: https://opendata.hira.or.kr/home.do
  12. Park C, Jang S, Jang S, et al. Identification and validation of osteoporotic hip fracture using the national health insurance database. J Korean Hip Soc. 2010;22:305-11. https://doi.org/10.5371/jkhs.2010.22.4.305
  13. Lee YK, Ha YC, Choi HJ, et al. Bisphosphonate use and subsequent hip fracture in South Korea. Osteoporos Int. 2013;24:2887-92. https://doi.org/10.1007/s00198-013-2395-5
  14. Jang SY, Cha YH, Mun YS, Kim SH, Kim HY, Choy WS. Acute cholecystitis in elderly patients after hip fracture: a nationwide cohort study. J Korean Med Sci. 2019;34:e36. https:// doi.org/10.3346/jkms.2019.34.e36
  15. Jang SY, Cha YH, Kim KJ, Kim HY, Choy WS. The effect of surgery type on mortality in elderly patients with per-trochanteric femoral fracture: a Korean nationwide cohort study. Asian J Surg. 2020;43:550-6. https://doi.org/10.1016/j.asjsur.2019.06.006
  16. Jang SY, Lee JW, Kim KJ, Kim HY, Choy WS, Cha Y. Comparative interrupted time series analysis of long-term direct medical costs in patients with hip fractures and a matched cohort: a large-database study. Clin Orthop Relat Res. 2022;480:891-902. https://doi.org/10.1097/CORR.0000000000002051
  17. Li YP, Propert KJ, Rosenbaum PR. Balanced risk set matching. J Am Stat Assoc. 2001;96:870-82. https://doi.org/10.1198/016214501753208573
  18. Lu B. Propensity score matching with time-dependent covariates. Biometrics. 2005;61:721-8. https://doi.org/10.1111/j.1541-0420.2005.00356.x
  19. Andersen LW, Granfeldt A, Callaway CW, et al. Association between tracheal intubation during adult in-hospital cardiac arrest and survival. JAMA. 2017;317:494-506. https://doi.org/10.1001/jama.2016.20165
  20. Suissa S, Moodie EE, Dell'Aniello S. Prevalent new-user cohort designs for comparative drug effect studies by time-conditional propensity scores. Pharmacoepidemiol Drug Saf. 2017;26:459-68. https://doi.org/10.1002/pds.4107
  21. Jang SY, Rou WS, Kim SH, Lee BS, Eun HS. Association between new-onset liver cirrhosis and suicide risk in South Korea: a nationwide cohort study. Clin Mol Hepatol. 2021;27:283-94. https://doi.org/10.3350/cmh.2020.0227
  22. Haukoos JS, Lewis RJ. The propensity score. JAMA. 2015;314:1637-8. https://doi.org/10.1001/jama.2015.13480
  23. Hallberg K, Williams R, Swanlund A, Eno J. Short comparative interrupted time series using aggregate school-level data in education research. Educ Res. 2018;47:295-306. https://doi.org/10.3102/0013189X18769302
  24. Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676-82. https://doi.org/10.1093/aje/kwq433
  25. Socci AR, Casemyr NE, Leslie MP, Baumgaertner MR. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J. 2017;99-B:128-33. https://doi.org/10.1302/0301-620X.99B1.BJJ-2016-0134.R1
  26. Roberts KC, Brox WT, Jevsevar DS, Sevarino K. Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015;23:131-7. https://doi.org/10.5435/JAAOS-D-14-00432
  27. Palm H, Jacobsen S, Sonne-Holm S, Gebuhr P. Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation. J Bone Joint Surg Am. 2007;89:470-5. https://doi.org/10.2106/JBJS.F.00679
  28. Tu DP, Liu Z, Yu YK, Xu C, Shi XL. Internal fixation versus hemiarthroplasty in the treatment of unstable intertrochanteric fractures in the elderly: a systematic review and meta-analysis. Orthop Surg. 2020;12:1053-64. https://doi.org/10.1111/os.12736
  29. Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: a review. Clin Interv Aging. 2018;13:143-50. https://doi.org/10.2147/CIA.S150067
  30. Kumar P, Rajnish RK, Sharma S, Dhillon MS. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop. 2020;44:623-33. https://doi.org/10.1007/s00264-019-04351-9
  31. Jolly A, Bansal R, More AR, Pagadala MB. Comparison of complications and functional results of unstable intertrochanteric fractures of femur treated with proximal femur nails and cemented hemiarthroplasty. J Clin Orthop Trauma. 2019;10:296-301. https://doi.org/10.1016/j.jcot.2017.09.015
  32. Steihaug OM, Gjesdal CG, Bogen B, Kristoffersen MH, Lien G, Ranhoff AH. Sarcopenia in patients with hip fracture: a multicenter cross-sectional study. PLoS One. 2017;12:e0184780. https://doi.org/10.1371/journal.pone.0184780
  33. Yoo JI, Cha YH, Kim KJ, Kim HY, Choy WS, Hwang SC. Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20:63. https://doi.org/10.1186/s12891-019-2450-2
  34. Tajima K, Yoshida M, Murakami D, et al. Primary bipolar hemiarthroplasty as a treatment option for unstable intertrochanteric fractures. Fujita Med J. 2020;6:122-7. https://doi.org/10.20407/fmj.2019-022