We found in the Medicare database that there is a relatively low rate of in-hospitality mortality associated with intertrochanteric hip fractures; this rate is lower than previously reported. We report a 1.70% in-hospital mortality using a complete Medicare dataset. Based on previous reporting for short term and one-year mortality risk, the present study suggests that mortality risk is greatest after patients have been released from the hospital. More attention should be paid to understanding and attenuating the mortality associated with intertrochanteric hip fractures after the acute hospital phase.

Increased risk of mortality with time has been established in association with femoral neck fractures. However, little is known about the in-hospital mortality risk associated with femoral neck fractures in the US population. This study was conducted to determine the in-hospital mortality rate associated with femoral neck fractures and to identify independent demographic features associated with an increased risk of this primary outcome. The authors queried the PearlDiver database (PearlDiver Technologies, Inc, West Conshohocken, Pennsylvania) of Medicare patients from 2005 to 2010 for International Classification of Diseases, 9th Revision (ICD-9), diagnostic codes for femoral neck fractures and related conditions. Stratified sampling was conducted by creating a group within the data set that included patients with a death discharge using ICD-9-D-820.0 through ICD-9-D-820.13. Age, sex, and year of injury were analyzed as specific demographic variables related to mortality. A total of 751,232 femoral neck fractures occurred during the index study period. There were 11,420 deaths during the initial hospital stay, for an overall mortality rate of 1.52%. The mortality rate in patients older than 84 years was 2.06%. Of all deaths, 89% occurred in patients who were 75 years and older. The mortality rate for femoral neck fractures was 1.22% in women and 2.32% in men (odds ratio, 0.5; 95% confidence interval, 0.25-1.04). The overall mortality rate for patients in the Medicare population who were treated at an inpatient center for femoral neck fractures from 2005 to 2010 was 1.5%. Men had a mortality rate almost twice that of women. Patients older than 84 years were the most likely to die soon after sustaining a femoral neck fracture.

Introduction:The in-hospital mortality rate after total shoulder arthroplasty (TSA) is unknown. The purpose of this study is to quantify the in-patient mortality rates and associated demographic risk factors for patients undergoing a TSA from 2005 to 2011 using a comprehensive Medicare registry database.Materials and Methods:We conducted a retrospective review of the Medicare database within the PearlDiver database. The PearlDiver database is a publicly available Health Insurance Portability and Accountability Act-compliant national database that captures 100% of the Medicare hospital data for TSA between 2005 and 2011. Using International Classification of Diseases, Ninth Revision codes for TSA we identified a dataset of patients undergoing TSA as well as a subset of those for whom there was a death discharge (i.e., in-patient death). Risk for this outcome was further quantified by age, gender and year. Linear regression was performed to identify risk factors for the primary outcome.Results:A total of 101,323 patients underwent 125,813 TSAs between 2005 and 2011. There were 113 in-patient mortalities during this period. Thus the incidence of death was 0.09%. Increasing age was a significant risk factor for mortality (P = 0.03). Gender and year of procedure were not significant risk factors for mortality.Conclusion:The incidence of in-patient mortality for Medicare patients undergoing TSA between 2005 and 2011 was <1 in 1000 surgeries. Increased age is a significant predictor of mortality.Level 4:Retrospective analysis

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