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Age-Based Heuristics Bias Treatment of Displaced Femoral Neck Fractures in the Elderly. Arthroplast Today 2024 Jun;27:101356

Date

03/25/2024

Pubmed ID

38524153

Pubmed Central ID

PMC10958215

DOI

10.1016/j.artd.2024.101356

Scopus ID

2-s2.0-85188002978 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Surgeons performing arthroplasty for femoral neck fractures may rely on mental shortcuts (heuristics) when choosing total hip arthroplasty (THA) vs hemiarthroplasty (HA). We sought to quantify the extent to which age-based heuristics drive decision-making.

METHODS: We identified all Medicare beneficiaries from 2017-2018 with femoral neck fractures who underwent THA or HA. We compared the likelihood of THA vs HA among patients admitted within 4 weeks before vs 4 weeks after their birthday for each age under the hypothesis that these cohorts would be similar except for numerical age. We controlled for race/ethnicity, sex, comorbidities, poverty status, and hospital census region in a multivariable regression that included facility-level cluster effects. We generated predicted/adjusted probabilities for THA vs HA for different age transition points.

RESULTS: Thirteen thousand three hundred sixty-six elderly patients were included. One thousand eight hundred sixty-five (14%) received THA and 11,501 (86%) received HA. The likelihood of THA decreased from 50.3% among patients almost 67 to 8% among those ≥85 (P < .001). We found significant decreases in likelihood of THA across age transitions. The largest decrement was at age transition 69 (THA likelihood 28.7% for newly 69 vs 43.3% for almost 69, 33.7% relative change). Female gender, Black race, higher comorbidity burden, and lower socioeconomic status were also associated with a lower likelihood of THA.

CONCLUSIONS: Our data demonstrate that patient age transitions seem to influence the choice of THA vs HA. Further research is needed to develop data-driven surgical decision aids for this population.

Author List

Edelstein AI, Tanenbaum JT, McGinley EL, Dillingham TR, Pezzin LE

Authors

Emily L. McGinley Biostatistician III in the Center for Advancing Population Science department at Medical College of Wisconsin
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of Wisconsin