![]() Patients who underwent surgical fixation of their fracture were then matched to those undergoing THA using a Greedy matching algorithm based on caliper matching with a caliper width defined at 0.20 standard deviations of the logit of the propensity score. Variables which were continuous (ie, age) were included as continuous variables, and those which were categorical (sex, comorbidity index, fracture type, smoking status) were included as categorical variables. This propensity score model included the variables listed in Table 1, Table 2. Individual propensity scores were calculated using binary logistic regression with surgery type (fixation or arthroplasty) as the outcome variable. ![]() To limit this influence, 1-to-1 propensity score matching was performed to ensure baseline patient characteristics were similar for both cohorts. Multiple baseline differences existed between cohorts for both the 40- to 49-year-olds and the 50- to 59-year-olds. Laterality modifiers were used to ensure reoperation was occurring on the same side as the index operation.īaseline characteristics were compared using chi-square analysis or independent samples t-tests. Irrigation and debridement included location-specific irrigation and debridement codes as well as CPT 2701 (removal of prosthesis, with or without antibiotic spacer). For the purposes of this study, we included the following as revision surgery: revision THA (in patients initially treated with THA CPT codes 27134, 27137, 27138), removal of components with or without placement of antibiotic spacer (ie, septic revision arthroplasty CPT codes 27090, 27091), conversion arthroplasty (in those treated initially with IF CPT codes 27130, 27132, 27125), revision fixation (CPT 27235, 27236), bone grafting (CPT 27170), free vascularized fibula transfer (CPT 20955), and femoral osteotomy and fixation (ie, valgus producing osteotomy, CPT 27165). Reoperation included both irrigation and debridement as well as revision surgery, and these procedures were identified by using CPT codes. We additionally collected reoperation data for 1 year and 3 years after surgery for those patients with adequate follow-up. Postoperative complications included postoperative sepsis, wound dehiscence, 90-day reoperation, myocardial infarction, postoperative anemia (hemoglobin <12 g/dL in women and <13 g/dL in men), pneumonia, acute kidney injury, and urinary tract infection. Health-care utilization parameters included the following: 30- and 90-day readmissions, 90-day emergency department (ED) visit, extended length of stay (LOS defined as >4 days), and non-home discharge (ie, discharge to subacute rehabilitation or skilled nursing facility). Postoperative utilization parameters and complication data were collected for 90 days postoperatively. While all fixation techniques (percutaneous pinning, intramedullary nail, sliding hip screw, and so on) were included given the nonspecific nature of CPT and ICD codes, only FNFs (and not intertrochanteric femur fractures) were included. These included the following ICD-9 codes and their ICD-10 equivalents: 820.8 (closed fracture of unspecified part of neck of femur), 820.0 (closed fracture of intracapsular portion of femoral neck), 820.01 (closed fracture of upper neck of femur), 820.02 (closed fracture of mid-cervical section of neck of femur), 820.03 (closed fracture of base of neck of femur). Patients initially undergoing hemiarthroplasty were not included in this study, and all included patients were confirmed to have a diagnosis of FNF using ICD-9 or ICD-10 diagnosis codes. ![]() Given the nonspecific nature of CPT code 27236, these patients were separated into THA or fixation cohorts using International Classification of Diseases (ICD) procedural codes (THA was identified using ICD-9 procedural code 81.51 and ICD-10 codes 0SRB and 0SR9 IF patients were identified using ICD-10 procedural codes 0QS604Z, 0QS606Z, 0QS636Z, 0QS644Z, and 0QS646Z and ICD-9 codes 79.15 and 79.35.). This was performed by using Current Procedural Terminology (CPT) codes, and the following codes were used: 27130 (THA), 27235 (percutaneous skeletal fixation of femoral fracture, proximal end, neck), 27236 (open treatment of femoral fracture, proximal end, neck, IF, or prosthetic replacement). The Truven database was queried from 2009 to 2018 to identify patients who had undergone THA for FNF or operative fixation of a FNF. ![]()
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