scholarly journals A Simple Diagnosis-Related Groups-Based Reimbursement System Is Cost Ineffective for Elderly Patients With Displaced Femoral Neck Fracture Undergoing Hemiarthroplasty in Beijing

2021 ◽  
Vol 8 ◽  
Author(s):  
Hui-ming Peng ◽  
Yuan Xu ◽  
Pu-wo Ci ◽  
Jia Zhang ◽  
Bao-zhong Zhang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Elderly Patients ◽  
Diagnosis Related Groups ◽  
Treatment Costs ◽  
Femoral Neck Fractures ◽  
Reimbursement System ◽  
Cost Of Treatment ◽  
Displaced Femoral Neck Fractures ◽  
Total Treatment ◽  
The Cost

Displaced femoral neck fractures (FNF) in the elderly are a major public health concern that necessitates hemiarthroplasty (HA) as the mainstay treatment option. Diagnosis-Related Groups (DRG) are a patient classification system that categorizes patients based on the resources expended on them. The first objective of this study was to evaluate if a simplified DRG-based reimbursement system in Beijing would lower total HA treatment costs for elderly patients with displaced FNF. In addition, we aimed to determine how age, gender, year of admission, length of in-hospital stay, and the Charlson index affected total treatment costs. This retrospective study included 513 patients from the Peking Union Medical College Hospital. The patients were diagnosed with unilateral displaced femoral neck fractures and had HA. Medical information was gathered, including baseline demographic and clinical data, as well as treatment costs. Patients were classified into two groups: those who spent more than the predetermined cut-off cost and those who did not. The cost did not include the use of a bipolar prosthesis. Data from the two groups were compared, and multiple regression analysis models were constructed. The median total cost of treatment was ¥49,626 ($7,316). The majority of the patients (89.7%; 460/513) were categorized as exceeding the cost cut-off. Multiple linear regression analysis revealed that total treatment cost was positively correlated with age (p < 0.01) and the duration of in-hospital stay (p < 0.01) but not with gender (p = 0.160) or the Charlson index (p = 0.548). On implementing the DRG-based reimbursement system, the overall treatment costs increased by ¥21,028 ($3,099) (p < 0.01). The implementation of simplified DRG-prospective payment systems did not result in a significant reduction in total treatment costs for elderly patients with FNF who underwent HA in Beijing. The overall cost of treatment was associated with several factors, including age, length of hospitalization, and year of admission.

OPERATIVE MANAGEMENT OF DISPLACED FEMORAL NECK FRACTURES IN ELDERLY PATIENTS

2005 ◽  
Vol 87 (9) ◽  
pp. 2122-2130 ◽  
Author(s):  
MOHIT BHANDARI ◽  
P. J. DEVEREAUX ◽  
PAUL TORNETTA ◽  
MARC F. SWIONTKOWSKI ◽  
DANIEL J. BERRY ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Elderly Patients ◽  
Operative Management ◽  
Femoral Neck Fractures ◽  
Displaced Femoral Neck Fractures

scholarly journals Comparing total hip arthroplasty and hemiarthroplasty for the treatment of displaced femoral neck fracture in the active elderly over 75 years old: a systematic review and meta-analysis of randomised control trials

2019 ◽  
Author(s):  
Liu Yijun ◽  
Chen Xiaokun ◽  
Zhang Peixun ◽  
Jiang Baoguo
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Hip Arthroplasty ◽  
Femoral Neck Fractures ◽  
Cochrane Library ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Operation Rate

Abstract Background: Displaced femoral neck fractures (DFNF) are increasingly common in elderly patients. Repair of DFNF can be completed using two methods, hemiarthroplasty (HA) or total hip Arthroplasty (THA). However, there is much controversy regarding whether HA or THA is superior in active elderly patients over 75 years old. Methods: We conducted the literature search by searching PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, and Web of Science from the inception dates to June 1, 2019. Randomised controlled trials (RCT) were included according to the inclusion and exclusion criteria. Included studies were analysed according to Cochrane review methods. Results: Nine studies met the inclusion criteria totalling 631 participants (301 THA and 330 HA）. Four of the studies conducted were identical to a previous study but look at different follow up measures. The analysis of previously collected data revealed that the THA group had a lower erosion rate, higher total pain and function HHS, and higher EQ-5Dindex. The re-operation rate was significantly lower in the THA group after five years of follow up after adding the patients with painful symptoms to the group of patients revised. However, THA had longer operative time and a higher dislocation rate in the first three years compared to the HA procedure. Moreover, there was an insignificant difference in mortality rate, general complications, wound infection, duration of hospital stay, and VTE prevalence among the two procedures. Conclusions: THA may be a preferred management option for active elderly patients over 75 years old, after careful evaluation of patients’ general condition and tolerance of surgery. Strict management and follow up protocols should be followed to prevent dislocation within the first three years following a THA. Trial registration: This study was registered at the International Prospective Register of Systematic Reviews (CRD42019139135). The date of registration is 16-06-2019. Keywords: displaced femoral neck fractures; total hip arthroplasty; hemiarthroplasty;

Comparison of functional outcome of cemented total hip replacement versus cemented dual-mobility cup total hip replacement for the management of displaced femoral neck fractures in the active elderly patients

2020 ◽  
pp. 112070002091041 ◽  
Author(s):  
Ramy A M Rashed ◽  
Hannah Sevenoaks ◽  
Qaisar A Choudry ◽  
Mohammed S Kasem ◽  
Tarek A Elkhadrawe ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Elderly Patients ◽  
Range Of Motion ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Femoral Neck Fractures ◽  
Dual Mobility ◽  
Total Hip ◽  
Displaced Femoral Neck Fractures ◽  
Hip Replacements

Introduction: Current guidelines recommend treating displaced femoral neck fractures with a total hip replacement in fit and active elderly patients. Dislocation remains the main complication. Dual-mobility cup (DMC) hip replacements maybe a solution to decrease dislocation, with the benefit of increasing stability, achieving better range of motion and functional outcomes. Patients and methods: This is a prospective randomised controlled trial which included 62 patients with Garden III and IV femoral neck fractures. The mean age was 67.2 years. 30 males and 32 females were included, randomised and allocated to 2 treatment groups; a cemented DMC replacement group, or a cemented 32-mm head total hip replacement (THR). The posterior approach was used in all patients. Postoperative functional outcome was assessed using Harris Hip Score (HHS). Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire. Results: The mean HHS for the DMC group at 4, 6 and 12 months were higher than mean HHS scores for the THR group ( p < 0.001). The range of motion at 1 year was statistically better in the DMC group compared to the THR group ( p < 0.001). The DMC showed a statistically better effect on the HRQoL measurements as compared to the THR group. There were no dislocations in both groups. Conclusions: DMC hip replacements provide better functional, patient reported outcomes, and range of motion than the conventional THR. Combined with its stability, DMC replacements are a useful solution in managing femoral neck fractures in active elderly patients. Trial serial number 020841 (IRB Number 00007555).

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