Effect of insurance type on Management of Vancouver B Periprosthetic Fractures: length of stay, discharge destination and cost implications.

Abstract

Background: To assess the effect of private versus public insurance on hospital length of stay, discharge destination, and costs in managing Vancouver B periprosthetic femoral fractures (PFF).

Methods: A retrospective cohort study of PFF patients operatively managed at five public trauma centers. The primary outcome was hospital length of stay. Secondary outcomes included discharge destination and costs related to implants and hospital beds.

Results: The study included 195 PFF cases (133 public, 62 private). Private patients had lower ASA scores (2.8 versus 3.1, P = 0.006) and were more likely to come from independent residences (87% versus 74%, P = 0.045). Private patients spent 8 fewer days in the hospital (12 ± 8 versus 20 ± 19 days, P < 0.001) and were more often discharged to rehabilitation (74% versus 48%, P = 0.003). Public hospital costs were higher for public patients ($37 456 versus $25 324, P = 0.005), largely due to longer stays. Implant costs were similar between private and public patients, but patients that underwent revision surgeries increased costs significantly compared to patients that underwent open reduction and internal fixation alone ($6257 versus $3511, P < 0.001).

Conclusion: Private insurance was linked to shorter hospital stays and increased discharge to rehabilitation. Public PPF patients incur an average cost of $37 456 for public hospitals, compared to $25 324 for private patients. Delays in public patient rehabilitation access may prolong hospital stays, suggesting a need for alternative care pathways, such as PPF tailored home-based rehabilitation and support programs.