Abstract:
OBJECTIVES:With the transition to a value-based model of care delivery, bundled payment models have been implemented with demonstrated success in elective lower extremity joint arthroplasty. Yet, hip fracture outcomes are dependent on patient-level factors that may not be optimized preoperatively due to acuity of care. The objectives of this study are to (1) develop a supervised naive Bayes machine-learning algorithm using preoperative patient data to predict length of stay and cost after hip fracture and (2) propose a patient-specific payment model to project reimbursements based on patient comorbidities. METHODS:Using the New York Statewide Planning and Research Cooperative System database, we studied 98,562 Medicare patients who underwent operative management for hip fracture from 2009 to 2016. A naive Bayes machine-learning model was built using age, sex, ethnicity, race, type of admission, risk of mortality, and severity of illness as predictive inputs. RESULTS:Accuracy was demonstrated at 76.5% and 79.0% for length of stay and cost, respectively. Performance was 88% for length of stay and 89% for cost. Model error analysis showed increasing model error with increasing risk of mortality, which thus increased the risk-adjusted payment for each risk of mortality. CONCLUSIONS:Our naive Bayes machine-learning algorithm provided excellent accuracy and responsiveness in the prediction of length of stay and cost of an episode of care for hip fracture using preoperative variables. This model demonstrates that the cost of delivery of hip fracture care is dependent on largely nonmodifiable patient-specific factors, likely making bundled care an implausible payment model for hip fractures.
journal_name
J Orthop Traumajournal_title
Journal of orthopaedic traumaauthors
Karnuta JM,Navarro SM,Haeberle HS,Billow DG,Krebs VE,Ramkumar PNdoi
10.1097/BOT.0000000000001454subject
Has Abstractpub_date
2019-07-01 00:00:00pages
324-330issue
7eissn
0890-5339issn
1531-2291journal_volume
33pub_type
杂志文章,多中心研究abstract::Opening an abdominal window in a hip spica type of cast can be a troubling maneuver for both orthopaedic surgeon and patient. We present a simple device to create an abdominal window more easily. ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200307000-00009
更新日期:2003-07-01 00:00:00
abstract::Successful operative intervention in displaced intra-articular calcaneal fractures depends in part on the maintenance of an anatomic reduction of the posterior facet. This guide describes our use of bioabsorbable implants to solve this problem. ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181ca38ce
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVES:This study was designed to evaluate the frequency of intraoperative problems and complications involved with Less Invasive Stabilization System (LISS) plate removal. DESIGN:Retrospective study. SETTING:Single academic level I trauma center. METHODS:Medical records were reviewed for demographics, surgical ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181c29bf5
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVES:To determine whether opioid use disorders (OUDs) are associated with adverse perioperative outcomes in patients undergoing surgical fixation for proximal femur fractures. METHODS:The National Hospital Discharge Survey was queried to identify patients surgically treated for proximal femur fractures between 1...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001118
更新日期:2018-05-01 00:00:00
abstract:OBJECTIVES:This study evaluated whether patients with a left-sided femoral neck fracture (FNF) treated with a sliding hip screw (SHS) had a higher implant failure rate than patients treated for a right-sided FNF. This was performed to determine the clinical relevance of the clockwise rotational torque of the femoral ne...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001934
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Hip fractures are associated with significant morbidity and mortality. Co-management models pairing orthopaedic surgeons with hospitalists or geriatricians may be effective at improving processes of care and outcomes such as length of stay (LOS) and cost. We set out to determine the effect of an integrated h...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000000691
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To determine the rate of pelvic vein thrombosis following acetabular or pelvic fracture identified by enhanced computed tomography venography or magnetic resonance venography. DESIGN:Prospective evaluation of computed tomography venography and magnetic resonance venography in patients with pelvic and acetabu...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200210000-00001
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVES:Lateral locked plating for proximal tibial fractures with metaphyseal disruption provides a biomechanically stable and biologically favorable alternative to conventional medial/lateral plate fixation. New polyaxial screw technology incorporates expanding screw bushings, allowing variable angle screw placemen...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/QAI.0b013e3181a25368
更新日期:2009-08-01 00:00:00
abstract:OBJECTIVES:To compare the efficacy of negative pressure wound therapy (NPWT) versus conventional dressings (CD) in the management of open fractures. DATA SOURCES:A systematic search of English articles in the PubMed/MEDLINE, Embase, and the Cochrane Library through April 2019 comparing NPWT versus CD in the management...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001750
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVES:To determine whether there is a patient-reported functional difference between combat-related knee disarticulations (KDs) and transfemoral amputations (TFAs). SETTING:Role 3 Military Trauma Centers. PATIENTS:We identified and contacted all KDs and TFAs performed at the Walter Reed National Military Medical...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001440
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVES:To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout. DESIGN:Retrospective comparative study. SETTING:Level I trauma center. PATIENTS/PARTICIPANTS:Patients treated wit...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001096
更新日期:2018-04-01 00:00:00
abstract::We reviewed the treatment and results of 22 Bennett's fractures. Of these fractures, treated by closed reduction and plaster immobilization, 20 were available for follow-up. Eighteen patients had a subjectively satisfactory outcome, and seven had a radiographically confirmed arthrosis of the first carpometacarpal join...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199502000-00004
更新日期:1995-02-01 00:00:00
abstract:BACKGROUND:Combined rupture of the anterior cruciate ligament (ACL) and patellar tendon (PT) is a rare injury pattern. Currently, little evidence exists to help guide management decisions for these patients. METHODS:A systematic literature search was conducted using PubMed (MEDLINE) and Scopus (EMBASE and MEDLINE) for...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001219
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVE:To determine whether stimulation with low-intensity ultrasound will reduce the radiologic healing time of fresh tibial shaft fractures fixed with a reamed and statically locked intramedullary rod. DESIGN:Prospective, randomized, double blinded, and placebo controlled. PATIENTS AND METHODS:Thirty-two adult p...
journal_title:Journal of orthopaedic trauma
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00005131-199905000-00005
更新日期:1999-05-01 00:00:00
abstract::Severe crush injuries to the midfoot often involve comminuted cuneiform or tarsal navicular fractures. Treatment principles for the bony injury of the crushed midfoot include maintenance of the medial column length and alignment, as well as appropriate stable fixation after open or closed fracture reductions. This is ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200308000-00007
更新日期:2003-08-01 00:00:00
abstract::This report presents a case demonstrating the nonunion of a capital femoral physeal fracture with a large metaphyseal fragment in a 10-year-old boy. To our knowledge, there is no previously reported case of this type of nonunion. The treatment of this nonunion presented a potential risk of premature physeal closure an...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e3181c83a3b
更新日期:2010-08-01 00:00:00
abstract::The difficulty in assessing femoral rotation during intramedullary nailing is well-established. Navigation systems allow the surgeon to detect and set the version of the injured leg at the desired angle. We report the first cases of navigated femoral nailing using noninvasive registration of the contralateral uninjure...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31812f69a9
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVES:To evaluate use of intraoperative fluoroscopy during acetabular surgery to determine fracture reduction and accurate placement of screws. DESIGN:Retrospective. SETTING:Level I trauma center. PARTICIPANTS:Thirty patients with thirty-two acetabular fractures. INTERVENTION:Patients were evaluated with fluor...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199908000-00004
更新日期:1999-08-01 00:00:00
abstract::Although the benefit of spinal canal decompression of traumatic thoracolumbar burst fractures is controversial, it remains a desirable procedure, as many reports describe improved neurologic outcome with spinal canal reconstruction. The optimal type of posterior instrumentation for reconstructing the spinal canal is u...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199112000-00004
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:To determine whether knee arthrodesis with simultaneous lengthening using the Ilizarov method for a nonreconstructable knee joint with bone loss and infection is a successful salvage procedure. DESIGN:Retrospective review of patients. SETTING:University hospital-based orthopaedic practice. PATIENTS:From 19...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200503000-00004
更新日期:2005-03-01 00:00:00
abstract::A retrospective review of 39 fractures of the femur in 37 patients caused by low- and mid-velocity handgun missiles treated with static interlocking nailing within 18 h of injury was conducted to evaluate the efficacy, safety, and cost savings of immediate intramedullary nailing in these injuries. Patients were follow...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199404000-00010
更新日期:1994-01-01 00:00:00
abstract::The 2-step closed reduction maneuver was developed to aid in the rarely encountered inferior shoulder dislocation. The maneuver converts the humeral head from an inferior dislocation to an anterior dislocation and then reduces the humeral head into the glenoid. The operator places one hand on the shaft of the humerus ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-200605000-00010
更新日期:2006-05-01 00:00:00
abstract:SUMMARY:We present the previously unreported complication of symptomatic heterotopic ossification of the quadriceps following placement of a large-diameter Steinmann pin for the purpose of temporary skeletal traction. Following the development of distal quadriceps heterotopic bone formation in three patients, we conduc...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/00005131-200404000-00010
更新日期:2004-04-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to examine the results of computed tomography angiography (CTA) obtained in patients with high-energy tibial plafond fractures and assess if the information gleaned from CTA could be useful to the treating orthopedic surgeon. DESIGN:Consecutive patient series. SETTING:Level 2 t...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e31815cf6e9
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:The purpose of the present study was to compare the biomechanical stability of C1 and C2 vertebrae after treatment of ligamentous instability by either modified Brooks posterior wiring (MB) or transarticular screw (TAS) techniques. We hypothesized that the TAS technique would be more stable because of direct ...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199909000-00004
更新日期:1999-09-01 00:00:00
abstract::Recent innovations have greatly increased the range of proximal humeral fractures that are amenable to open reduction and plate fixation.The optimum technique for some of the more complex fracture patterns is not yet fully refined.This article aims to describe the recent advances in the treatment of complex proximal h...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:10.1097/BOT.0b013e31821c0a2f
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Calcaneal fractures comprise 1 to 2 percent of all fractures. Approximately 75% of calcaneal fractures are intra-articular. The management of intra-articular calcaneal fractures remains controversial. Nonoperative treatment options include elevation, ice, early mobilization, and cyclic compression of the pla...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章,评审
doi:
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVES:Retrospective evaluation of the long-term outcomes after surgical treatment of traumatic patellar dislocations in adolescents and identification of possible predictive factors of poor outcomes. DESIGN:Retrospective clinical study. SETTING:University Clinic, Level I Trauma Center. PATIENTS:All 33 adolescen...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0b013e318299cb50
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVES:To compare the hospital costs, charges, and reimbursement for treatment of pediatric femur fractures by two treatment methods: external fixation and 90-90 traction with spica casting. DESIGN:Retrospective clinical review. SETTING:Department of Orthopaedic Surgery, Children's Hospital Oakland, regional pedi...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/00005131-199811000-00006
更新日期:1998-11-01 00:00:00
abstract::Nail plate combination technique can be applied in the setting of periprosthetic and interprosthetic fractures to promote reliable healing with a biomechanically favorable construct. Here, technical aspects and discussion of the technique are reviewed through a case of an 87-year-old woman who suffered from an interpr...
journal_title:Journal of orthopaedic trauma
pub_type: 杂志文章
doi:10.1097/BOT.0000000000001571
更新日期:2019-09-01 00:00:00