Surgery to repair a hip fracture adds years of patient life quality and mobility
Study finds reduced lifetime healthcare costs of more than $65,000 per patient
Many people find it hard to imagine the vulnerability of falling and breaking a hip. Not only is the injury frightening, there are many personal concerns such as an increased risk of mortality or of permanent debilitation; and a loss of work and quality of life. Many worries loom large for the more than 300,000 Americans, primarily adults over age 65, who sustain a hip fracture. These injuries not only threaten independence and mobility, but present long-term financial costs to patients, families, insurers and government agencies. And while surgery, the primary treatment for hip fractures, successfully reduces mortality risk and improves physical function, little is known about the procedure’s value and return on investment.
A new study, appearing in the journal Clinical Orthopaedics and Related Research (CORR), found that average lifetime societal benefits in the U.S. reduced the direct medical costs of hip fracture surgery by $65,000 to $68,000 per patient (in 2009 dollars), and that total, lifetime societal savings exceeded $16 billion for older patients. These savings resulted from a reduction in the length and intensity of care after the injury, as well as a reduction in the amount of longer-term medical care and assistance needed by patients who undergo surgery for a hip fracture, when compared with those who are treated without surgery.
For example, when Jimmy Ming Hsu was traveling to China, he slipped in the shower and fractured his right hip. He was able to have his hip repaired, and this has helped him regain his mobility and get back to his active life. Patient Margo A. not only was able to get back to her busy life and spending time with her husband but also to a demanding job that she loves. Immobility simply wasn’t an option for these two patients!
The risk for hip fractures, a break in the upper quarter of the femur (thigh) bone, increases substantially with age with approximately 90 percent of hip fractures occurring in people older than age 65. As the number of older Americans continues to grow, the incidence of hip fracture is expected to increase substantially. The article stated that the annual incidence of hip fractures is expected to exceed 500,000 by 2040.
In addition to the video at the top of this page, more information is available here:
- Multimedia Portal with Audio and Video Assets
- AAOS News Release on the Society Impact of Hip Fracture Repair
- Audio News release on hip fracture repair study
- Video of disc fracture surgery patient Margo A.
- Video of Fred Redfern, MD, discussing the value of hip fracture surgery
- Video of AAOS past president, John R. Tongue, MD on studying the value of orthopaedic care
The full study, which received financial support from the American Academy of Orthopaedic Surgeons (AAOS), is available at ANationInMotion.org/value/hip-fracture.
Frequently Asked Questions
- What does it mean to fracture or break your hip?
A hip fracture, or broken hip, is a break in the upper quarter of the femur, also known as the thigh bone. Hip fractures most often occur because of a direct hit to the hip or a fall. Ninety percent of the more than 300,000 Americans who suffer from this traumatic injury each year are older than age 65 and surgical repair of the broken hip is the preferred method of treatment for most healthy patients to maintain overall health and mobility.
- Since surgical treatment for hip fractures does not appear to be elective surgery, why was it important to include this in your research?
Surgery is usually necessary for hip fractures. We know that patients who have surgery when they break their hip live longer and have better mobility than those who do not receive surgery.Although most patients tend to be older or elderly, we found this doesn’t mean there isn’t an impact on the workforce. People are delaying retirement and therefore the sooner they can recover from this surgery, the faster they can return to their life.
- What data was used to determine these findings?Based on a literature review, analysis of Medicare claims data and the input of a panel of clinical experts, the researchers created a Markov model ─ a standard predictive tool that accounts for various possible outcomes ─ to measure the cost and potential savings of repairing hip fractures via surgery.This is the first study to evaluate the impact of hip fracture surgery on a comprehensive set of economic outcomes – including long-term medical costs, home modification costs and costs associated with long-term nursing home care – compared with not undergoing surgery among patients age 65 and older.The effectiveness of treatment was expressed in quality adjusted life years (QALYs), which take into account the patient’s life expectancy together with the patient’s level of physical function.
- What was the conclusion?
The specific findings included:
- While surgical costs to repair fractures were initially approximately $20,000 higher, these costs were offset by savings from lower long-term medical costs.
- The lifetime cost of a hip fracture is estimated at $81,300, of which approximately 44 percent of the costs were associated with nursing facility expenses.
- The lifetime total per-patient societal savings from surgical treatment of hip fractures was estimated at $160,000.
- For the population over age 65 as a whole, the annual total societal savings is estimated at $16 billion.
- How will this be used in the future and what is its impact on health care costs?
This is the first study to examine the total societal impact of surgical repair of hip fractures. Our hope is that the findings from this study and the model used to determine the value of treatment can also be applied to other medical procedures, to educate policymakers and ultimately ensure we are receiving maximum value for health care dollars spent.