Non-union is a common complication following long bone fractures, often requiring significant incremental healthcare resources. The payer cost of long bone non-union in patients with or without concurrent infection is not well documented. Our study evaluated 2-year incremental healthcare costs of non-union in patients with fractures.

Tibial fractures are more likely to occur secondary to osteoporosis than any other fractures. Intramedullary nailing (IMN) is a widely used method for treating tibial fractures. This study assessed the complications, reoperations and reimbursement associated with these within one-year of IMN in tibial fractures for patients with osteoporosis or osteopenia, representing poor bone quality. This retrospective cohort study used the IBM® Marketscan® Commercial database from 2007-2018. All patients with a diagnosis of osteoporosis or osteopenia between 18-64 years who underwent fixation with an intramedullary implant for a tibial fracture were included. Proportion of patients with complications including non-union, malunion, deep infection and mechanical complications along with reoperations within one-year of IMN were reported. Adjusted reimbursements over one-year period were compared between patients with and without the top two complications and reoperations using generalized linear models with log-link function and gamma distribution. A total of 225 patients (Mean [SD] age, 50.3 [13.6] years, 75.6% female) with osteoporosis or osteopenia requiring IMN for tibial fractures were included in the analysis. Over the one-year period after IMN, 15.1% had nonunion, 7.6% had mechanical complications, 4.4% had deep infection and 1.3% had malunion. Reoperations were reported among 23.1% patients. After adjusting for demographic and clinical factors, the mean reimbursements were statistically significantly higher among patients with reoperations ($48,495 vs $15,921), nonunion ($35,317 vs $20,185) and mechanical complications ($44,949 vs $20,695) as compared to patients without the complications (All P<0.0001). A high proportion of patients with osteoporosis or osteopenia (23%) required a second tibial surgery after initial fixation with an IMN. Patients with complications required at least 1.7 times higher reimbursements than those without. Novel tibial nailing systems that would reduce the need for reoperations and lower the risk of complications are warranted in patients with poor bone quality.

Intramedullary nailing (IMN) is a widely used method for treating tibial fractures. This study evaluated the frequency of reoperation within one-year of initial intramedullary fixation for patients with tibial fractures and compared one-year healthcare payments among patients with and without reoperation. This retrospective cohort study used patient-level data from the IBM® Marketscan® Commercial database. All patients between 18-64 years who underwent fixation with an IMN for a tibial fracture between 2007-2018 were included. Reoperations were defined as presence of a second tibial surgery with known and unknown laterality within one-year of initial intramedullary fixation. Reoperations associated with non-union were also reported. Adjusted healthcare payments over one-year period were compared between patients with and without reoperations using generalized linear models with log-link function and gamma distribution. A total of 6,082 patients (Mean age, 37.6 years, 37.9% female) were included in the analysis. A second tibial surgery within one year after the IMN procedure was performed in 1,463 (24.1%) patients of which 449 (7.4%) patients had records for ipsilateral reoperations and 337 (5.5%) had reoperations associated with non-union. The most common conditions for reoperations were removal of implant, complications with the implant, pain, non-union and infection. After adjusting for demographic and clinical factors, the mean payments were statistically significantly higher among patients with any reoperations ($32,607 vs $11,220), ipsilateral reoperations ($31,888 vs $11,180) and reoperations due to nonunion ($51,100 vs $11,270) as compared to patients without reoperations (All P<0.0001). A high proportion of patients (24%) required a second tibial surgery after initial fixation with an IMN. Compared to patients without reoperation, patients with any or ipsilateral reoperations had healthcare payments 2.9 times higher and patients with reoperations for non-union had healthcare payments 4.5 times higher. Novel tibial nailing systems are warranted that would reduce the need for reoperation.

Fractures of the distal femur are most commonly treated with plates and screws. This study evaluated the one-year incidence of complications and their associated costs (reimbursement) for patients treated with plating/screws for fixation of distal femur fracture (DFF). This retrospective observational cohort analysis used patient-level data from the Medicare Standard Analytic File (2015Q4 to 2018Q1). Patients were 65 years of age or older with an insurance claim for DFF and plating/screws during the episode of care for which Medicare was the primary payor. One-year post-fixation incidence for infection, deep infection, delayed healing, and nonunion were quantified. One-year post index reimbursement related to these complications was calculated when any of these complications were listed as primary on any insurance claim. Subgroup analysis was performed for patients with evidence of a prior total knee arthroplasty (TKA) on the same side as the DFF. A total of 11,527 patients had a plating/screw procedure for a DFF diagnosis and were included in the analysis; among these patients 9.8% (n=1,128) had a prior TKA. The mean (standard deviation [SD]) age for the cohort was 80(8.6) years. Eight-four percent of the cohort were female, and most patients had a closed fracture (96.0%). The one-year incidence of complication was 4.5% for nonunion, 3.8% for delayed healing, 2.8% for infection, and 1.9% for deep infection. The respective mean (SD) one-year reimbursement for these complications was as follows: nonunion $13,565 ($7,192), delayed healing $14,281 ($11,057), and infection $16,544 ($13,927), and deep infection $18,984 ($20,345). Complications were the same or slightly lower with evidence of a prior TKA. Complications following DFF with plating/screws are costly. Improved surgical methods and technologies could reduce these complications thereby reducing healthcare system costs.

Fractures of the distal femur, and their treatment with an intramedullary nail, are becoming increasingly more common. This study evaluated the one-year incidence of complications and their associated costs (reimbursement) for patients treated with an intramedullary nail(IMN) for fixation of distal femur fracture(). This retrospective observational cohort analysis used patient-level data from the Medicare Standard Analytic File(2015Q4 to 2018Q1). Patients were 65 years of age or older with an insurance claim for DFF and an IMN procedure during the episode of care for which Medicare was the primary payor. One-year post-fixation incidence for infection, deep infection, delayed healing, and nonunion were quantified. One-year post index reimbursement related to these complications was calculated when any of these complications were listed as primary on any insurance claim. Subgroup analysis was performed for patients with evidence of a prior total knee arthroplasty(TKA) on the same side as the DFF. A total of 3,070 patients had an IMN procedure for a DFF diagnosis and were included in the analysis; among these patients 8.0%(n=247 ) had a prior TKA. The mean (standard deviation [SD]) age for the cohort was 80(8.8) years. Eighty-three percent of the cohort was female, and most patients had a closed fracture(96.4%). The one-year incidence of complications was 3.3% for delayed healing, 3.0% for nonunion, 1.5% for deep infection, and 1.4% for infection. The respective mean(SD) one-year reimbursement for these complications was as follows: delayed healing $1,794($3,454), nonunion $7,027($11,915), deep infection $6,496($9,793), and infection $18,949($21,858). With the exception of nonunion, all other evaluated complications were similar or lower 1-year reimbursement rates among those with evidence of a prior TKA. Complications following DFF are costly and in the case of nonunion having a prior TKA increases the financial burden. Improved surgical methods and technologies could reduce these complications thereby reducing healthcare system costs.

To estimate the healthcare resource utilization and medical payments among patients receiving treatment for acetabulum fractures in the United States. This retrospective cohort study included IBM® Marketscan® Commercial and Medicare databases. Adult patients (≥18 years) with a diagnosis of acetabulum fracture who received a treatment with an internal fixation device between 2010-2018 were included. The outcome measures included hospital length of stay (LOS), payments for the initial internal fixation hospitalization, and all-cause readmission and reoperation rates and their associated incremental payments over one-year post-acetabulum surgery. Generalized linear regression models controlling for demographic and clinical factors and method of least-squares means were used to calculate adjusted incremental payments for readmission and reoperation. A total of 1,929 patients in the commercial and 330 patients in Medicare databases were identified. The mean (standard deviation, SD) age of the cohort was 43.0 (14.2) years with 72.9% males in commercial and 75.8 (7.4) years with 57.3% males in Medicare. The mean (SD) hospital LOS were 11.6 (10.5) days and 10.4 (8.8) days and the mean payments for initial treatment hospitalization were $104,213 (119,693) and $49,353 (64,968) for commercial and Medicare populations respectively. Over the one-year post-surgery, the rates of readmission were 28.6% and 37.6% and the adjusted incremental payments were $67,871 and $53,830 for commercial and Medicare populations, respectively. The rates of reoperation were 7.7% and 13.3% and the adjusted incremental payments were $57,841 and $29,663 for commercial and Medicare populations, respectively. Patients receiving treatment for acetabulum fractures not only have long length of stay and burdensome medical payments for initial acetabulum procedure but also have high one-year readmission and reoperation rates and associated incremental payments. Treatment options that could reduce unplanned readmissions and reoperations representing significant potential cost savings to both the hospital and the health care system is warranted.