Defining a Hip Fracture: Surveying Orthopaedic Surgeons to Better Characterize the Injury.

Abstract

Entities such as The Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality include a large swath of heterogenous hip fracture diagnoses together when defining this injury. However, it is unclear if these broad definitions are in line with those of physicians who treat these injuries. We queried orthopaedic surgeons to understand how they would define a hip fracture and how their definition compares with the ones currently in use by healthcare agencies. We conducted an internet-based survey of orthopaedic surgeons to ascertain which standard hip fracture types they felt should be included in a modified hip fracture definition (MHFD), along with querying their current treatment practices. We also compared outcomes, medical comorbidities, and spending across patients captured in the different diagnosis groups. Eighty-five orthopaedic surgeons completed the survey, and almost all of them felt that a femoral neck (96.5%) and intertrochanteric (95.3%) fracture should be included in the MHFD, while almost half (49.4%) would include the subtrochanteric region, and just over a quarter (27.1%) would incorporate the femoral head or a stable greater or lesser trochanter fracture. Treatment practices were largely in line with current research and patients captured by the new MHFD tended to have more procedures performed, have higher inpatient costs, and be discharged to higher levels of care compared with hip fracture patients not included in this new definition. There should be caution when using current hip fracture definitions from healthcare agencies because they do not align well with those used by practicing orthopaedic surgeons. Efforts to enhance this definition should be explored because quality improvement programs are limited by a heterogenous definition of this injury.