A cost analysis of treating postoperative periprosthetic femoral fractures following hip replacement surgery in a UK tertiary referral centre

Aim: This study aims to evaluate costs associated with periprosthetic femoral fracture (PFF) treatment at a UK tertiary referral centre. Methods: This study included 128 consecutive PFFs admitted from 02/04/2014-19/05/2020. Financial data were provided by Patient Level Information and Costing Systems. Primary outcomes were median cost and margin. Secondary outcomes were length of stay, blood transfusion, critical care, 30-day readmission, 2-year local complication, 2-year systemic complication, 2-year reoperation and 30-day mortality rates. Statistical comparisons were made between treatment type. Statistical significance was set at p < 0.05. Results: Across the cohort, median cost was 15,644.00 pound (IQR 11,031.0 pound 0-22,255.0 pound 0) and median loss was 3757.50 pound (599.20- pound 8296.20) pound. The highest costs were ward stay (3994.00 pound, IQR 1,765.00- pound 7,013.00) pound, theatre utilisation (2962.0 pound 0, IQR 0.0 pound 0-4,286.0 pound 0) and overheads (1705.10 pound, IQR 896.70- pound 2432.20) pound. Cost (17,455.0 pound 0 [IQR, 13,194.0 pound 0-23,308.0 pound 0] versus 7697.0 pound 0 [IQR 3871.0 pound 0-10,847.0 pound 0], p < 0.0 01) and loss (4890.0 pound 0 [IQR 1308.0 pound 0-10,0 pound 09.0 0] versus 1882.0 pound 0 [IQR 313.0 pound 0-3851.0 pound 0], p = 0.02) were greater in the operative versus the nonoperative group. There was no difference in cost (17,634.0 pound 0 [IQR 12,965.0 pound 0-22,958.00] pound versus 17,399.00 pound [IQR 13,394.00- pound 23,404.00] pound, p = 0.98) or loss (5374.00 pound [IQR 1950.00- pound 10,143.0 pound 0] versus 3860.0 pound 0 [IQR -95.50- pound 7601.0 pound 0], p = 0.21) between the open reduction and internal fixation (ORIF) and revision groups. More patients required blood transfusion in the operative versus the nonoperative group (17 [17.9%] versus 0 [0.0%], p = 0.009). There was no difference in any clinical out-come between the ORIF and revision groups (p > 0.05). Conclusion: PFF treatment costs are high with inadequate reimbursement from NHS tariff. Work is needed to address this disparity and reduce hospital costs. Cost should not be used to decide between ORIF and revision surgery.Crown Copyright (c) 2022 Published by Elsevier Ltd. All rights reserved.