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Comparison of Short-term Complication Rates Between Cephalomedullary Hip Screw Devices and Sliding Hip Screws

An Analysis of the National Surgical Quality Improvement Program Database

Pandarinath, Rajeev, MD; Amdur, Richard, PhD; DeBritz, James N., MD; Rao, Raj D., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: December 1, 2018 - Volume 26 - Issue 23 - p 845–851
doi: 10.5435/JAAOS-D-16-00818
Research Article

Background: The literature pertaining to the management of intertrochanteric hip fractures using cephalomedullary hip screws (CMHSs) and sliding hip screws (SHSs) has shown varying results. CMHS use has increased over time without validation of its superiority in the literature.

Methods: We conducted a retrospective cohort study using the American College of Surgeons National Quality Improvement Program database. Patients who had sustained a peritrochanteric hip fracture were identified. Short-term (<30 day) complications were identified with adjustments made for preoperative comorbidities. We also examined the relative percentages of CMHS and SHS surgeries over time.

Results: A total of 14,415 subjects met the inclusion criteria. Patients undergoing SHS surgery were generally healthier, having a lower American College of Surgeon class, preoperative bleeding, hypertension, pulmonary risk factors, congestive heart failure, and higher preoperative hematocrit. After adjusting for demographics and comorbidities, we noted a higher rate of 30-day mortality (odds ratio [OR] = 1.19; P = 0.024), bleeding (OR = 1.10; P = 0.007), pulmonary complications (OR = 1.19; P = 0.049), and clotting events (OR = 1.35; P = 0.035) in the CMHS group. We observed a higher rate of urinary tract infection (OR = 0.81; P = 0.023) and length of stay (1.0 days; P < 0.0001) in the SHS group. The overall percentage of SHS cases was 33% and trended lower over time.

Conclusions: Although differences in complication subtypes and the overall complication rate were found, further multicenter, randomized controlled trials would be helpful in elucidating differences between the treatment groups. The popularity of the CMHS continues to increase over time.

From the Department of Orthopedic Surgery, The George Washington University, Washington, DC.

Correspondence to Dr. Pandarinath:

Dr. Pandarinath or an immediate family member has stock or stock options held in Procter & Gamble and AstraZeneca and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Dr. Rao or an immediate family member serves as a board member, owner, officer, or committee member of the US Food and Drug Administration. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Amdur and Dr. DeBritz.

© 2018 by American Academy of Orthopaedic Surgeons
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