The Added Burden of Transfer Status in Patients Undergoing Surgery After Sustaining a Periprosthetic Fracture of the Hip or Knee

Background A significant proportion of patients who sustain periprosthetic fractures are transferred to another institution for definitive care. There is limited understanding of the impact of transfer on outcomes. Methods The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was utilized to identify patients who sustained periprosthetic fractures of the hip or knee requiring surgical intervention. Inclusion criteria were total joint prosthesis of the hip or knee with documented periprosthetic fracture of a single hip or knee along with surgery during hospitalization. Transfer status and discharge location were recorded. A total of 1,194 non-transferred patients were compared to 620 transferred patients. Cohorts were compared utilizing standard parametric and non-parametric tests depending on the characteristics of the data. Results Transferred patients had a higher mean age (75.6 years vs. 72.9 years, p < 0.0001), longer mean length of stay (7.9 days vs. 6.9 days, p = 0.0023), and greater American Society of Anesthesiologists (ASA) grade. Transferred patients were less likely to be discharged home (p = 0.0001) and more likely to be discharged to hospice (p = 0.049) or rehabilitation facilities (p = 0.0001). No significant differences were detected regarding readmissions or complications. In transferred patients, having lower preoperative albumin was a risk factor for readmission within 30 days. Conclusion Transfer centers accepting and treating periprosthetic fractures should be aware that these patients often have a longer length of stay and are less likely to be discharged home. However, the data suggests these patients are well cared for, given the similar complication rates.