Does Implant Choice Affect the Episode Cost of Pertrochanteric Hip Fracture for US Veterans?

Objective: To investigate an association between a surgeon's choice of a cephalomedullary nail (CMN) or sliding hip screw (SHS) with the cost of treating a pertrochanteric hip fracture.

Design: Multicenter retrospective cohort study.

Setting: US Veterans Health Administration Sierra Pacific Network.

Patients/participants: Two hundred ninety-four consecutive US veterans admitted for a principal diagnosis of an OTA/AO 31A-type pertrochanteric hip fracture of a native hip from 2000 to 2015.

Intervention: Internal fixation using a CMN or an SHS.

Main Outcome Measurements: Veterans Administration Health Economic Resource Center average national cost estimate of combined acute and postacute care episode cost, excluding implant cost, normalized to 2015 US dollars by the Consumer Price Index.

Results: Median episode cost was $8223 lower with a CMN than an SHS (95% confidence interval, $5700-$10,746, P < 0.001) after matching on a propensity score for treatment with a CMN based on age, sex, body mass index, Charlson Comorbidity Index, fracture characteristics, study site, and admission year. A subgroup propensity-matched analysis excluding reverse obliquity pertrochanteric fractures was not sufficiently powered to detect a difference in episode cost (β = 0.76, P = 0.311).

Conclusions: Implant choice significantly affected the episode cost of care of hip fracture at Veterans Health Administration facilities.

Level Of Evidence: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.