Data on Medicare and Medicaid Discussed by Researchers at Louisiana State University (Bone fracture nonunion rate decreases with increasing age: A…

Data on Medicare and Medicaid Discussed by Researchers at Louisiana State University (Bone fracture nonunion rate decreases with increasing age: A prospective inception cohort study)

By a News Reporter-Staff News Editor at Insurance Weekly News -- Current study results on Medicare and Medicaid have been published. According to news reporting originating from New Orleans, Louisiana, by VerticalNews correspondents, research stated, "Fracture nonunion risk is related to severity of injury and type of treatment, yet fracture healing is not fully explained by these factors alone. We hypothesize that patient demographic factors assessable by the clinician at fracture presentation can predict nonunion."

Financial support for this research came from Bioventus LLC.

Our news editors obtained a quote from the research from Louisiana State University, "A prospective cohort study design was used to examine similar to 2.5 million Medicare patients nationwide. Patients making fracture claims in the 5% Medicare Standard Analytic Files in 2011 were analyzed; continuous enrollment for 12 months after fracture was required to capture the ICD-9-CM nonunion diagnosis code (733.82) or any procedure codes for nonunion repair. A stepwise regression analysis was used which dropped variables from analysis if they did not contribute sufficient explanatory power. In-sample predictive accuracy was assessed using a receiver operating characteristic (ROC) curve approach, and an out-of-sample comparison was drawn from the 2012 Medicare 5% SAF files. Overall, 47,437 Medicare patients had 56,492 fractures and 2.5% of fractures were nonunion. Patients with healed fracture (age 75.0 +/- 12.7 SD) were older (p < 0.0001) than patients with nonunion (age 69.2 +/- 13.4 SD). The death rate among all Medicare beneficiaries was 4.8% per year, but fracture patients had an age and sex-adjusted death rate of 11.0% (p < 0.0001). Patients with fracture in 14 of 18 bones were significantly more likely to die within one year of fracture (p < 0.0001). Stepwise regression yielded a predictive nonunion model with 26 significant explanatory variables (all, p<= 0.003). Strength of this model was assessed using an area under the curve (AUC) calculation, and out-of-sample AUC = 0.710. A logistic model predicted nonunion with reasonable accuracy (AUC = 0.725). Within the Medicare population, nonunion patients were younger than patients who healed normally. Fracture was associated with increased risk of death within 1 year of fracture (p < 0.0001) in 14 different bones, confirming that geriatric fracture is a major public health issue. Comorbidities associated with increased risk of nonunion include past or current smoking, alcoholism, obesity or morbid obesity, osteoarthritis, rheumatoid arthritis, type II diabetes, and/or open fracture (all, multivariate p< 0.001)."

According to the news editors, the research concluded: "Nonunion prediction requires knowledge of 26 patient variables but predictive accuracy is currently comparable to the Framingham cardiovascular risk prediction."

For more information on this research see: Bone fracture nonunion rate decreases with increasing age: A prospective inception cohort study. Bone, 2017;95():26-32. Bone can be contacted at: Elsevier Science Inc, 360 Park Ave South, New York, NY 10010-1710, USA. (Elsevier - www.elsevier.com; Bone - www.journals.elsevier.com/bone/)

The news editors report that additional information may be obtained by contacting R. Zura, Louisiana State University, Dept. of Orthopaed Surg, New Orleans, LA, United States. Additional authors for this research include M.J. Braid-Forbes, K. Jeray, S. Mehta, T.A. Einhorn, J.T. Watson, G.J. Della Rocca, K. Forbes and R.G. Steen.

Keywords for this news article include: New Orleans, Louisiana, United States, North and Central America, Medicare and Medicaid, Bone Fractures, Risk and Prevention, Epidemiology, Bone Research, Health Policy, Medicare, Louisiana State University.

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