Original Article Mortality and Financial Burden of Periprosthetic Fractures of the Femur

Objective: This study examines patient factors to identify risks of 12-month mortality following periprosthetic femur fractures. Hospital charges were analyzed to quantify the financial burden for treatment modalities. Methods: Data were retrospectively analyzed from a prospective database at a university hospital setting. One-hundred and thirteen patients with a periprosthetic fracture of the proximal or distal femur were identified. Risk factors for 12-month mortality were analyzed, and financial data were compared between the various treatment modalities. Results: In all, 14 % of patients died (16 of 113) within 3 months and the 1-year mortality was 17.7 % (20 of 113). Patients who died within 1 year had higher hospital charges (US$33 880+ 25 051 vs US$22 886+ 16 841; P .01) and were older (87.6+ 8.5 vs 81.5+ 8.6; P .004). Logistic regression analysis revealed age was the only significant predictor of 1-year mortality (P .029, odds ratio 1.1). Analysis of financial data revealed 4 distinct groups (P <.05 between groups). Distal femoral revision arthroplasty (RA-DF) generated the highest hospital charges of US$91 035+ 25 579 (n 3). The second most highly charged group included proximal femoral fractures treated with revision arthroplasty (US$34 078+ 17 832; n 20) and hemi/total hip arthroplasty (THA; US$41 556+ 23 651; n 8). The third most charged group under-went open reduction internal fixation of the proximal (US$18 706+ 6829; n 35) and distal (US$22 381+ 10 835; n 35) femur. Nonoperative treatment generated the lowest charges (US$6426+ 2899; n 11). On average, the hospital lost money treating patients with RA-DF (US$19 080+ 2022 per patient) and hemi/THA (US$6594+ 9305 per patient), while all othe