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Direct and indirect costs of surgically treated pelvic fractures

Archives of Orthopaedic and Trauma Surgery volume 136, pages 325–330 (2016)Cite this article

Abstract

Introduction

Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism).

Materials and methods

We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism.

Results

The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p < 0.001) and hospitalization in the surgical unit (p = 0.008).

Conclusions

Pelvic fractures are associated with both high direct costs and substantial productivity loss.

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References

  1. Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H (2005) Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Brit 87(1):2–9

    CAS  PubMed  Google Scholar 

  2. Guthrie HC, Owens RW, Bircher MD (2010) Fractures of the pelvis. J Bone Joint Surg Brit 92(11):1481–1488

    Article  CAS  PubMed  Google Scholar 

  3. Nicodemo A, Decaroli D, Pallavicini J, Sivieri R, Aprato A, Masse A (2008) A treatment protocol for abdomino-pelvic injuries. J Orthop Traumatol 9(2):89–95

    PubMed Central  Article  PubMed  Google Scholar 

  4. Vallier HA, Parker NA, Beddow ME (2014) Reasons for transfer to a level 1 trauma center and barriers to timely definitive fracture fixation. J Orthop Trauma 28:e284–e289

    Article  PubMed  Google Scholar 

  5. Judet R, Judet J, Letournel E (1964) Fractures of the acetabulum: classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg Am 46:1615–1646

    CAS  PubMed  Google Scholar 

  6. Tile M (1988) Pelvic ring fractures. Should they be fixed? J Bone Joint Surg Br 70(1):1–12

    CAS  PubMed  Google Scholar 

  7. Tan SS, Bakker J, Hoogendoorn ME et al (2012) Direct cost analysis of intensive care unit stay in four European countries: applying a standardized costing methodology. Value Health 15(1):81–86

    Article  PubMed  Google Scholar 

  8. Adam T, Evans DB, Murray CJ (2003) Econometric estimation of country-specific hospital costs. Cost effectiveness and resource allocation: C/E; 1(1):3 (Italian). http://www.who.int/choice/country/ita/cost/en/. Accessed 1 Oct 2014

  9. Macario A (2010) What does one minute of operating room time cost? J Clin Anesth 22(4):233–236

    Article  PubMed  Google Scholar 

  10. Stargardt T (2008) Health service costs in Europe: cost and reimbursement of primary hip replacement in nine countries. Health Econ 17(1 Suppl):S9–S20

    Article  PubMed  Google Scholar 

  11. Santini V, Truschi F, Bertelli A, Lazzaro C (2013) Cost of red blood cell transfusion: an activity-based cost description. Drugs Cell Ther Hematol 2(2):157–167

    Article  Google Scholar 

  12. Piscitelli P, Iolascon G, Argentiero A et al (2012) Incidence and costs of hip fractures vs strokes and acute myocardial infarction in Italy: comparative analysis based on national hospitalization records. Clin Interv Aging 7:575–583

    PubMed Central  Article  PubMed  Google Scholar 

  13. AIFA Italian Medicines Agency—Agenzia Italiana del Farmaco. (2014) Liste di Trasparenza. http://www.agenziafarmaco.gov.it/it/content/liste-di-trasparenza-15042013. Accessed October 1 2014. Italian

  14. Bank of Italy. La ricchezza delle famiglie italiane [Survey on Household Income and Wealth]; 2014

  15. Yoshihara H, Yoneoka D (2014) Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. J Trauma Acute Care Surg 76:380–385

    Article  PubMed  Google Scholar 

  16. Curtis K, Lam M, Mitchell R, Dickson C, McDonnell K (2014) Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis. Aust health Rev 38(1):30–37

    Article  PubMed  Google Scholar 

  17. Kay HF, Sathiyakumar V, Yoneda ZT et al (2014) The effects of American Society of Anesthesiologists physical status on length of stay and inpatient cost in the surgical treatment of isolated orthopaedic fractures. J Orthop Trauma 28(7):e153–e159

    Article  PubMed  Google Scholar 

  18. Stergiannis P, Katsoulas T, Fildissis G et al (2014) Health-related quality of life and rehabilitation cost following intensive care unit stay in multiple trauma patients. J Trauma Nurs 21(3):115–121

    Article  PubMed  Google Scholar 

  19. Pizanis A, Pohlemann T, Burkhardt M, Aghayev E, Holstein JH (2013) Emergency stabilization of the pelvic ring: clinical comparison between three different techniques. Injury 44:1760–1764

    Article  CAS  PubMed  Google Scholar 

  20. Vallier HA, Cureton BA, Patterson BM (2013) Factors affecting revenue from the management of pelvis and acetabulum fractures. J Orthop Trauma 27(5):267–274

    Article  PubMed  Google Scholar 

  21. Adam T, Evans DB, Murray CJ (2003) Econometric estimation of country-specific hospital costs Cost effectiveness and resource allocation: C/E 2003, 1(1):3. http://www.who.int/choice/country/deu/cost/en/. Accessed 1 Oct 2014, (Italian)

  22. Taheri PA, Butz DA, Greenfield LJ (2000) Length of stay has minimal impact on the cost of hospital admission. J Am Coll Surg 191(2):123–130

    Article  CAS  PubMed  Google Scholar 

  23. Tibbs BM, Kopar P, Dente CJ, Rozycki GS, Feliciano DV (2008) Acetabular and isolated pelvic ring fractures: a comparison of initial assessment and outcome. Am Surg 74(6):538–541

    PubMed  Google Scholar 

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Acknowledgements

The authors thank Elke Rometsch and all the AOCID (AO Clinical Investigation and Documentation) staff for the help in preparing the manuscript. The corresponding author was supported by the AO foundation via an AO Trauma fellowship at AOCID.

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Affiliations

  1. Medical School, University of Turin, Turin, Italy

    Alessandro Aprato, Ferdinando Tosto, Alessandro Stucchi & Alessandro Massè

  2. Clinical Investigation and Documentation (C.I.D.) Department, AO Foundation, Dübendorf, Switzerland

    Alexander Joeris & Vasiliki Kalampoki

Authors
  1. Alessandro Aprato
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  2. Alexander Joeris
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  3. Ferdinando Tosto
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  4. Vasiliki Kalampoki
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  5. Alessandro Stucchi
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  6. Alessandro Massè
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Correspondence to Alessandro Aprato.

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Aprato, A., Joeris, A., Tosto, F. et al. Direct and indirect costs of surgically treated pelvic fractures. Arch Orthop Trauma Surg 136, 325–330 (2016). https://doi.org/10.1007/s00402-015-2373-9

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  • DOI: https://doi.org/10.1007/s00402-015-2373-9

Keywords

  • Pelvic ring injuries
  • Acetabular fracture
  • Cost analysis
  • Morbidity
  • Work productivity