Routine 2-Week Postoperative Radiographs After Geriatric Hip Fracture Fixation: Low Utility and High Cost

Abstract

Background: Geriatric hip fractures are associated with a large financial burden on both patients and payors, yet minimal data exist regarding postoperative cost optimization and guidelines for delivering high-value care. We assessed the utility and cost of routine radiographs at the first postoperative visit (FPOV) after fixation of geriatric hip fractures. Methods: We retrospectively evaluated patients with isolated geriatric hip fractures treated with internal fixation between January 2018 and September 2020. Medical records were reviewed to assess whether radiographs at the FPOV changed management. Direct costs of radiographs at the FPOV were estimated using Medicare Fee Schedule data. Indirect costs were estimated by assessing transportation costs. National costs were estimated by extrapolating institutional and Medicare data to the estimated 300,000 to 500,000 annual hip fractures in the United States. Results: Two hundred forty-one patients were included. A majority had intertrochanteric fractures (80%), were injured because of a ground-level fall (94%), and received long intramedullary nails (73%). One patient (1/241, 0.41%) had their postoperative management changed by FPOV radiographs, and that patient had an acute reinjury before their FPOV. Patients discharged home (50/241, 21%) traveled mean 51.3 miles each way, and those discharged to another facility (191/241, 79%) traveled mean 24.1 miles each way. The national estimated direct cost of routine radiographs at the FPOV totaled $10.9 to $18.2 m annually. The national indirect costs are estimated to be $1.2 to $1.9 m annually for patients discharged home and $63.4 to $105.7 m annually for patients discharged to a facility. Conclusions: Routine radiographs at the FPOV after internal fixation of geriatric hip fractures may not change management and should only be obtained when specifically indicated. Elimination of routine radiographs and conduction of the FPOV virtually by telemedicine could result in national cost savings of estimated $75.5 to $125.8 m annually without compromising quality of care.