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In France, distance from hospital and health care structure impact on outcome after arthroplasty of the hip for proximal fractures of the femur

Authors :
Mathieu Levaillant
Louis Rony
Jean-François Hamel-Broza
Julien Soula
Benoît Vallet
Antoine Lamer
Source :
Journal of Orthopaedic Surgery and Research, Vol 18, Iss 1, Pp 1-7 (2023)
Publication Year :
2023
Publisher :
BMC, 2023.

Abstract

Abstract Background Hip arthroplasty is a frequently performed procedure in orthopedic surgery, carried out in almost all health structures for two main issues: fracture and coxarthrosis. Even if volume–outcome relationship appeared associated in many surgeries recently, data provided are not sufficient to set surgical thresholds neither than closing down low-volumes centers. Question With this study, we wanted to identify surgical, health care-related and territorial factors influencing patient’ mortality and readmission after a HA for a femoral fracture in 2018 in France. Patients and methods Data were anonymously collected from French nationwide administrative databases. All patients who underwent a hip arthroplasty for a femoral fracture through 2018 were included. Patient outcome was 90-day mortality and 90-day readmission rate after surgery. Results Of the 36,252 patients that underwent a HA for fracture in France in 2018, 0.7% died within 90-day year and 1.2% were readmitted. Male and Charlson comorbidity index were associated with a higher 90-day mortality and readmission rate in multivariate analysis. High volume was associated with a lower mortality rate. Neither time of travel nor distance upon health facility were associated with mortality nor with readmission rate in the analysis. Conclusion Even if volume appears to be associated with lower mortality rate even for longer distance and time of travel, the persistence of exogenous factors not documented in the French databases suggests that regionalization of hip arthroplasty should be organized with caution. Clinical relevance As volume–outcome relationship must be interpreted with caution, policy makers should not regionalize such surgery without further investigation.

Details

Language :
English
ISSN :
1749799X
Volume :
18
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Journal of Orthopaedic Surgery and Research
Publication Type :
Academic Journal
Accession number :
edsdoj.9821d7b9820d4a33bad14fceb919c60a
Document Type :
article
Full Text :
https://doi.org/10.1186/s13018-023-03893-4