Costs and Complications of Short Versus Long Cephalomedullary Nailing of OTA 31-A2 Proximal Femur Fractures in U.S. Veterans

Abstract

Objectives: In fractures without subtrochanteric extension, the indications for the use of short versus long cephalomedullary nails (CMNs) for intertrochanteric femur fractures are unclear. We hypothesized that long nails would be associated with higher costs and similar complication rates.

Design: Retrospective comparative study.

Setting: United States Department of Veterans Affairs Medical Centers.

Participants: Patients receiving CMNs for OTA 31-A2 pertrochanteric fractures from 2001 to 2010.

Interventions: Short versus long cephalomedullary nailing.

Main outcome measurements: Costs, perioperative complications, readmissions, surgical failures, and mortality.

Results: We identified 262 patients with OTA 31-A2 pertrochanteric fractures (125 treated with short CMNs and 137 treated with long CMNs). The 2 cohorts had similar demographic and medical characteristics. There were no significant differences in perioperative complications, readmissions within 30 days, surgical failures within one year, or death within 30 days or one year. The average cost of hospitalization was significantly higher for the cohort treated with long nails (greater than $7000 in actual costs, and greater than $3000 when statistically adjusted for differences in postoperative lengths of stay). Multivariable analyses showed no significant differences in the rates of development of at least one complication, readmission, or death.

Conclusions: In a cohort of patients with similar characteristics and fracture patterns, the use of long CMNs was associated with similar rates of complications, readmission, and reoperations, but significantly higher costs than with the use of short nails.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.