Introduction: Intertrochanteric fractures account for almost 50% of hip fractures and 44% of all hip fracture costs in the US. Intramedullary nails are used for the fixation of these fractures. This study aimed to assess the differences in inpatient costs for patients treated with ITCS compared SHB in US hospitals.

Methods: We conducted a retrospective cohort study using PREMIER database from January 2017 to July 2019. All hospital inpatient admissions hip fracture diagnosis (DRG codes 480, 481, 482 or ICD codes for displaced or non-displaced) were included if they received either ITCS or SHB device. The primary endpoint was total inpatient cost calculated as continuous variables using generalized estimating equation models (supply, surgical, implant, recovery room and miscellaneous costs). Propensity matching was used to control for patients’ demographics, clinical and providers’ characteristics.

Results: After matching 2,564 and 11,473 patients treated with ITCS and SHB respectively were included with a mean age of 79 years. Total costs per patient were $16,927 (SD $7,690) for ITCS and $17,641 (SD $7,721) for SHB resulting in statistically significant cost savings of $714 (95% CI $383 to $1,044) in favor of ITCS. More patients treated with ITCS were discharged to home and skilled nursing facilities while fewer patients were discharged to rehabilitation centres (differences not statistically significant). Furthermore, patients treated with ITCS are more likely to require less opioid use measured by morphine equivalent mean 115.74mg vs 119.18mg p=0.20.

Conclusions: ITCS is estimated to reduce the inpatient costs compared to SHB in patients with intertrochanteric fractures. Further benefits are seen in opioid use and discharge destinations although these differences are not statistically significant. More evidence is needed to access if these hold in the longer term.

*ITCS- InterTAN™ Smith + Nephew, Memphis TN

**SHB- Proximal Femoral Nail Antirotation (TFNA)™ DePuy Synthes, West Chester, PA