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Fonkoue L, Tissingh EK, Muluem OK, Kong D, Ngongang O, Tambekou U, Handy D, Cornu O, McNally M. Predictive factors for fracture-related infection in open tibial fractures in a Sub-Saharan African setting. Injury 2023:110816. [PMID: 37246113 DOI: 10.1016/j.injury.2023.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The management of open tibial fractures (OTF) is challenging in low and middle-income countries (LMICs) where appropriate human resources and infrastructure (including equipment, implants and surgical supplies) are not readily available and medical care is not readily accessible. OTF are not rarely associated with a subsequent fracture-related infection (FRI), which is one of the most devastating and difficult to cure complications in orthopaedic trauma care. The aim of this study was to determine the rate and the predictive factors of FRI in OTF in a limited-resource setting of sub-Saharan Africa. METHODS Patients with OTF who underwent surgery from July 2015 to December 2020 and followed-up for at least 12 months in a tertiary care teaching hospital in Yaoundé (Cameroon) were retrospectively investigated. Diagnosis of FRI was based on the confirmatory criteria of the International FRI Consensus definition. All patients with bone infections, occurring at any time point during follow-up, were included. Logistic regression was used to determine the predictive factors for FRI. RESULTS One hundred and five patients with OTF were studied. With a mean follow-up period of 29.5 ± 16.6 months, 33 patients (31.4%) presented with FRI. Gustilo-Anderson type of OTF, compliance with antibiotics, blood transfusion, time to first washing of the wounds and method of bone fixation were factors associated with the occurrence of FRI. In multivariable logistic regression, 6-hours delay to first washing of the wounds (OR=8.07, 95% CI: 1.43-45.31, p = 0.01), and compliance with antibiotics (OR=11.33, 95%CI: 1.11-115.6, p = 0.04) were the only independent predictors of FRI. CONCLUSION The overall rate of FRI in open tibial fracture is still high in the sub-Saharan African context. For similar low-resources settings, this study supports the recommendations (1) to perform a very early washing-dressing-splinting of OTF on admission of the patient, (2) to administer antibiotics early, and (3) to perform surgery as soon as reasonably possible, once appropriate personnel, equipment, implants and surgical supplies are available.
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Affiliation(s)
- Loïc Fonkoue
- Department of Orthopedics and Trauma, Yaoundé General Hospital, Yaoundé, Cameroon; Department of surgery and specialties, University of Yaoundé 1, Yaoundé PO Box 5408, Cameroon; Department of Orthopedics and Trauma, Yaoundé Emergency Center, Yaoundé, Cameroon.
| | - Elizabeth K Tissingh
- Royal National Orthopedic Hospital NHS TRUST, United Kingdom of Great Britain and Northern Ireland. United Kingdom; King's Global Health Partnerships, School of Life Course and Population Sciences, King's College London, United Kingdom of Great Britain and Northern Ireland, London, United Kingdom
| | - Olivier Kennedy Muluem
- Department of Orthopedics and Trauma, Yaoundé General Hospital, Yaoundé, Cameroon; Department of surgery and specialties, University of Yaoundé 1, Yaoundé PO Box 5408, Cameroon
| | - Denis Kong
- Department of surgery and specialties, University of Yaoundé 1, Yaoundé PO Box 5408, Cameroon
| | - Olivier Ngongang
- Department of Orthopedics and Trauma, Yaoundé Emergency Center, Yaoundé, Cameroon
| | - Urich Tambekou
- Department of Orthopedics and Trauma, Yaoundé Emergency Center, Yaoundé, Cameroon
| | - Daniel Handy
- Department of surgery and specialties, University of Yaoundé 1, Yaoundé PO Box 5408, Cameroon
| | - Olivier Cornu
- Department of Orthopedics and Trauma, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Martin McNally
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, United Kingdom of Great Britain and Northern Ireland, Oxford, United Kingdom
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Hadfield JN, Omogbehin TS, Brookes C, Walker R, Trompeter A, Bretherton CP, Gray A, Eardley WGP. The Open-Fracture Patient Evaluation Nationwide (OPEN) study : epidemiology of open fracture care in the UK. Bone Jt Open 2022; 3:746-752. [PMID: 36181319 PMCID: PMC9626856 DOI: 10.1302/2633-1462.310.bjo-2022-0079.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIMS Understanding of open fracture management is skewed due to reliance on small-number lower limb, specialist unit reports and large, unfocused registry data collections. To address this, we carried out the Open Fracture Patient Evaluation Nationwide (OPEN) study, and report the demographic details and the initial steps of care for patients admitted with open fractures in the UK. METHODS Any patient admitted to hospital with an open fracture between 1 June 2021 and 30 September 2021 was included, excluding phalanges and isolated hand injuries. Institutional information governance approval was obtained at the lead site and all data entered using Research Electronic Data Capture. Demographic details, injury, fracture classification, and patient dispersal were detailed. RESULTS In total, 1,175 patients (median age 47 years (interquartile range (IQR) 29 to 65), 61.0% male (n = 717)) were admitted across 51 sites. A total of 546 patients (47.1%) were employed, 5.4% (n = 63) were diabetic, and 28.8% (n = 335) were smokers. In total, 29.0% of patients (n = 341) had more than one injury and 4.8% (n = 56) had two or more open fractures, while 51.3% of fractures (n = 637) occurred in the lower leg. Fractures sustained in vehicle incidents and collisions are common (38.8%; n = 455) and typically seen in younger patients. A simple fall (35.0%; n = 410) is common in older people. Overall, 69.8% (n = 786) of patients were admitted directly to an orthoplastic centre, 23.0% (n = 259) were transferred to an orthoplastic centre after initial management elsewhere, and 7.2% were managed outwith specialist units (n = 81). CONCLUSION This study describes the epidemiology of open fractures in the UK. For a decade, orthopaedic surgeons have been practicing in a guideline-driven, network system without understanding the patient features, injury characteristics, or dispersal processes of the wider population. This work will inform care pathways as the UK looks to the future of trauma networks and guidelines, and how to optimize care for patients with open fractures.Cite this article: Bone Jt Open 2022;3(10):746-752.
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Affiliation(s)
- James N. Hadfield
- Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, UK,Correspondence should be sent to James N. Hadfield. E-mail:
| | | | - Charlotte Brookes
- Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, UK
| | - Reece Walker
- Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, UK
| | | | | | - Andrew Gray
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - William G. P. Eardley
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK,Clinical Trials Unit, University of York, York, UK,Teesside University, Middlesbrough, UK
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Png ME, Petrou S, Bourget-Murray J, Knight R, Trompeter AJ, Costa ML. Association between the Orthopaedic Trauma Society classification of open fractures and economic costs. Bone Joint J 2022; 104-B:408-412. [PMID: 35227087 DOI: 10.1302/0301-620x.104b3.bjj-2021-1237.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to investigate the relationship between the Orthopaedic Trauma Society (OTS) classification of open fractures and economic costs. METHODS Resource use was measured during the six months that followed open fractures of the lower limb in 748 adults recruited as part of two large clinical trials within the UK Major Trauma Research Network. Resource inputs were valued using unit costs drawn from primary and secondary sources. Economic costs (GBP sterling, 2017 to 2018 prices), estimated from both a NHS and Personal Social Services (PSS) perspective, were related to the degree of complexity of the open fracture based on the OTS classification. RESULTS Adjusted mean total NHS and PSS costs were £13,785 following treatment of complex fractures and £3,550 following treatment of simple fractures, where the open fracture wound is closed at the end of the first wound debridement, generating a mean difference of £10,235 (95% confidence interval £8,074 to £12,396). CONCLUSION Following previous work correlating clinical outcomes with the OTS classification of open fractures, this study suggests that the new OTS classification also correlates with economic costs estimated from alternative study perspectives. Cite this article: Bone Joint J 2022;104-B(3):408-412.
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Affiliation(s)
- May E Png
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Ruth Knight
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alex J Trompeter
- Orthopaedic Trauma and Limb Reconstruction Unit, St George's University Hospital, London, UK
| | - Matt L Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Kadoorie Centre, University of Oxford, Oxford, UK
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Natalwala I, Chuo CB, Shariatmadari I, Barlow G, Moulder E, Bates J, Sharma H. Outcomes and Incidence of Deep Bone Infection in Grade III Diaphyseal Open Tibial Fractures: Circular Fixator vs Intramedullary Nail. Strategies Trauma Limb Reconstr 2022; 16:161-167. [PMID: 35111255 PMCID: PMC8778722 DOI: 10.5005/jp-journals-10080-1536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction High-energy grade III open fractures of tibia are associated with significant complications and generate debate over the ideal fixation method. This study compares the clinical outcomes for circular frame fixation (CFF) vs intramedullary nail fixation (IMF) in grade III open tibial fractures. Materials and methods Single-centre retrospective study of patients admitted from January 2008 to December 2016. All patients with grade III open diaphyseal tibial fractures (AO 42 A, B, C), treated with either CFF or IMF, were included. The primary outcome was deep bone infection (DBI). Secondary outcomes were delayed or non-union, secondary intervention, and amputation. Results A total of 48 limbs in 47 patients had CFF, and 25 limbs in 23 patients had IMF. Median time to definitive fixation was significantly longer for CFF at 9 days (IQR 3–13) compared to IMF at 1 day (IQR 0–3.5) (p <0.001). The DBI rate was significantly lower (2 vs 16%) in the CFF group (p = 0.04). There were 14 limbs (29%) with delayed or non-union in the CFF group vs 5 limbs (20%) in the IMF group. In the CFF group, significantly more limbs required bone grafting for delayed or non-union (p = 0.03). However, there was a greater proportion of limbs in the CFF group with segmental fractures or bone loss (46 vs 4%) and these high-energy fracture patterns were associated with secondary bone grafting (p = 0.005), and with delayed or non-union (p = 0.03). A subgroup analysis of patients without segmental fractures or bone loss treated with either CFF or IMF showed no significant difference in secondary bone grafting (p >0.99) and delayed or non-union rates (p = 0.72). Overall, one patient in each group went on to have an amputation. Conclusion Our study found that CFF had a lower rate of DBI compared to IMF. Injuries with high-energy fracture patterns (segmental fractures or bone loss) were more likely to have delayed or non-union and require secondary bone grafting. These factors should be considered when selecting the appropriate method of definitive fixation. How to cite this article Natalwala I, Chuo CB, Shariatmadari I, et al. Outcomes and Incidence of Deep Bone Infection in Grade III Diaphyseal Open Tibial Fractures: Circular Fixator vs Intramedullary Nail. Strategies Trauma Limb Reconstr 2021;16(3):161–167.
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Affiliation(s)
- Ibrahim Natalwala
- Department of Plastic Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
- Ibrahim Natalwala, Department of Plastic Surgery, Hull University Teaching Hospitals, Hull, United Kingdom, e-mail:
| | - Cher Bing Chuo
- Department of Plastic Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Isla Shariatmadari
- Department of General Surgery, Bristol Hospitals NHS Trust, Bristol, United Kingdom
| | - Gavin Barlow
- Department of Infectious Diseases, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Elizabeth Moulder
- Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Joanna Bates
- Department of Radiology, Hull University Teaching Hospitals, Hull, United Kingdom
| | - Hemant Sharma
- Department of Trauma and Orthopaedic Surgery, Hull University Teaching Hospitals, Hull, United Kingdom
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Roberts HJ, Donnelley CA, Haonga BT, Kramer E, Eliezer EN, Morshed S, Shearer D. Intramedullary nailing versus external fixation for open tibia fractures in Tanzania: a cost analysis. OTA Int 2021; 4:e146. [PMID: 34746677 PMCID: PMC8568384 DOI: 10.1097/oi9.0000000000000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Open tibia fractures pose a clinical and economic burden that is disproportionately borne by low-income countries. A randomized trial conducted by our group showed no difference in infection and nonunion comparing 2 treatments: external fixation (EF) and intramedullary nailing (IMN). Secondary outcomes favored IMN. In the absence of clear clinical superiority, we sought to compare costs between EF and IMN. DESIGN Secondary cost analysis. SETTING Single institution in Tanzania. PATIENTS/PARTICIPANTS Adult patients with acute diaphyseal open tibia fractures who participated in a previous randomized controlled trial. INTERVENTION SIGN IMN versus monoplanar EF. MAIN OUTCOME MEASUREMENTS Direct costs of initial surgery and hospitalization and subsequent reoperation: implant, instrumentation, medications, disposable supplies, and personnel costs.Indirect costs from lost productivity of patient and caregiver.Societal (total) costs: sum of direct and indirect costs.All costs were reported in 2018 USD. RESULTS Two hundred eighteen patients were included (110 IMN, 108 EF). From a payer perspective, costs were $365.83 (95% CI: $332.75-405.76) for IMN compared with $331.25 ($301.01-363.14) for EF, whereas from a societal perspective, costs were $2664.59 ($1711.22-3955.25) for IMN and $2560.81 ($1700.54-3715.09) for EF. The largest drivers of cost were reoperation and lost productivity. Accounting for uncertainty in multiple variables, probabilistic sensitivity analysis demonstrated that EF was less costly than IMN from the societal perspective in only 55% of simulations. CONCLUSIONS Intramedullary nail fixation compared with external fixation of open tibia fractures in a resource-constrained setting is not associated with increased cost from a societal perspective.
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Affiliation(s)
- Heather J Roberts
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Claire A Donnelley
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - Billy T Haonga
- Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania
| | - Erik Kramer
- Yale University School of Medicine, New Haven, CT
| | | | - Saam Morshed
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
| | - David Shearer
- Department of Orthopaedic Surgery, Institute for Global Orthopaedics and Traumatology, University of California San Francisco, San Francisco, CA
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Cay P, Leung B, Curlewis K, Stone A, Roper T, Ricketts D. Quotation errors related to the Distal Radius Acute Fracture Fixation Trial paper. J Hand Surg Eur Vol 2021; 46:654-658. [PMID: 33757322 DOI: 10.1177/17531934211002985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Quotation error is an inaccuracy in the assertions made by authors when referencing another's work. This study aimed to assess the quotation errors in articles referencing the Distal Radius Acute Fracture Fixation Trial (DRAFFT). A literature search was performed to identify all citations of DRAFFT from 2014 to 2020. The relevant publications were assessed by two reviewers using a validated framework of error classification. There were 83 articles containing references to DRAFFT. There was substantial agreement between the two reviewers (Kappa coefficient 0.66). We found 22/83 (28%) of articles contained an error, with one article containing two errors. There were 12 major errors, which were not substantiated by, were unrelated to or contradicted the findings of DRAFFT, and 11 minor errors, including numerical inaccuracies, oversimplification or generalization. This study highlights that a significant number of articles inaccurately quote DRAFFT. Authors and journals should consider checking the accuracy of key referenced statements.
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Affiliation(s)
- Peter Cay
- Trauma and Orthopaedics Department, Royal Sussex County Hospital, Brighton, UK
| | - Brook Leung
- Trauma and Orthopaedics Department, Royal Sussex County Hospital, Brighton, UK
| | - Keegan Curlewis
- Trauma and Orthopaedics Department, Royal Sussex County Hospital, Brighton, UK
| | - Andrew Stone
- Trauma and Orthopaedics Department, Royal Sussex County Hospital, Brighton, UK
| | - Tom Roper
- Trauma and Orthopaedics Department, Royal Sussex County Hospital, Brighton, UK
| | - David Ricketts
- Trauma and Orthopaedics Department, Royal Sussex County Hospital, Brighton, UK
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Thompson JW, Haddad FS. Integrated care systems in trauma to elective care: Can we emulate the integration of services in orthopaedic trauma care within elective practice? Bone Jt Open 2021; 2:411-413. [PMID: 34157862 PMCID: PMC8244793 DOI: 10.1302/2633-1462.26.bjo-2021-0113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Joshua W Thompson
- Department of Trauma and Orthopaedic Surgery, University College London Hospital Foundation NHS Trust, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospital Foundation NHS Trust, London, UK.,The Bone & Joint Journal, London, UK
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Sun S, Yang L, Hu X, Zhu Y, Liu B, Yang Y, Wang X. The burden of the current curative expenditure of injury in Dalian, China-a study based on the "system of health accounts 2011". BMC Public Health 2021; 21:157. [PMID: 33468078 PMCID: PMC7814588 DOI: 10.1186/s12889-021-10164-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injury is one of the major public health problems and causes more than 5 million deaths in the world annually. Cases of specific types of injury are life-threatening and heavily-burdened to individuals and society. This study was aimed to assess the financial burden of injury on patients. METHODS A total of 565 medical institutions were selected with multistage stratified cluster random sampling, containing 152,553 valid samples. Subsequently, the distribution of injury current curative expenditure (CCE) in different dimensions (including age and site of injury) was analyzed under the framework of System of Health Accounts 2011 (SHA 2011) using the established database. RESULTS In China, both urban and rural injury mortality rates showed an upward trend of more than 5 percentage points from 2006 to 2016. In Dalian, the CCE of injury reached 1572.73 million RMB, accounting for 7.45% of the total CCE. Those aged 15-24 reported larger proportion of CCE than the other age groups. As for the injuries in body parts, injuries occurred to the spine, lower limb, head and foreign body cost most. CONCLUSIONS Dalian has a relatively serious burden of injury costs. The essential and primary goal is to reduce the cost. Young people should pay attention to protect their head and limbs from injury, and related government sectors should implement preventive and educative measures.
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Affiliation(s)
- Shu Sun
- The First Affiliated Hospital of China Medical University, No.155 Nanjing Beijie, Heping District, Shenyang, Liaoning Province, P.R. China, 110001
| | - Liuna Yang
- School of public health, Songshan Lake National High-tech Industrial Development, Guangdong Medical University, No.1 Xincheng Blvd, Zone, Dongguan, Guangdong Province, P.R. China, 523808
| | - Xinzhu Hu
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China, 110122
| | - Yalan Zhu
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China, 110122
| | - Boxi Liu
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China, 110122
| | - Yunbin Yang
- Southern Medical University, 1023-1063 Shatai south road, Guangzhou, Guangdong Province, P.R. China, 510515
| | - Xin Wang
- College of the Humanities and Social Sciences, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning Province, P.R. China, 110122.
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Pley C, Purohit K, Krkovic M, Abdulkarim A. A health economic analysis of the management of open lower limb fractures in the elderly. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2020; 30:1383-1391. [PMID: 32519071 PMCID: PMC7680339 DOI: 10.1007/s00590-020-02713-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/31/2020] [Indexed: 11/16/2022]
Abstract
AIM The aim of this study was to investigate the financial implications of the inpatient management of open lower limb fractures in adults over 65 years old. Further, the study compares the calculated cost to the income received by the hospital for these patients and to the existing body of literature. METHODS This study employed direct inpatient costing analysis to estimate the cost of treating the open lower limb fractures incurred by 58 patients over the age of 65 years treated in our centre (Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust) between March 2014 and March 2019. RESULTS The median cost of inpatient care calculated in this study was £20,398 per patient, resulting in a financial loss to the hospital of £5113 per patient. When the results were disaggregated by sex, the median cost for an open lower limb fracture in a male patient was £20,886 compared to £19,304 in a female patient. Data were also disaggregated by the site of injury, which produced a median cost for an open femur fracture of £23,949, and £24,549 and £15,362 for open tibia and ankle fractures, respectively. CONCLUSION This study provides a valuable estimate of the expense of treating open lower limb fractures in patients over the age of 65 years in a Major Trauma Centre in England. The study highlights the large losses incurred by hospitals in treating these cases, and supports revision of the remuneration structures in the National Health Service to adequately cover their cost.
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Affiliation(s)
- Caitlin Pley
- School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Katie Purohit
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Petrou S, Parker B, Masters J, Achten J, Bruce J, Lamb SE, Parsons N, Costa ML. Cost-effectiveness of negative-pressure wound therapy in adults with severe open fractures of the lower limb: evidence from the WOLLF randomized controlled trial. Bone Joint J 2019; 101-B:1392-1401. [DOI: 10.1302/0301-620x.101b11.bjj-2018-1228.r2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Aims The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb. Patients and Methods An economic evaluation was conducted from the perspective of the United Kingdom NHS and Personal Social Services, based on evidence from the 460 participants in the Wound Management of Open Lower Limb Fractures (WOLLF) trial. Economic outcomes were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires. Bivariate regression of costs (given in £, 2014 to 2015 prices) and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained associated with NPWT dressings. Sensitivity and subgroup analyses were undertaken to assess the impacts of uncertainty and heterogeneity, respectively, surrounding aspects of the economic evaluation. Results The base case analysis produced an incremental cost-effectiveness ratio of £267 910 per QALY gained, reflecting higher costs on average (£678; 95% confidence interval (CI) -£1082 to £2438) and only marginally higher QALYS (0.002; 95% CI -0.054 to 0.059) in the NPWT group. The probability that NPWT is cost-effective in this patient population did not exceed 27% regardless of the value of the cost-effectiveness threshold. This result remained robust to several sensitivity and subgroup analyses. Conclusion This trial-based economic evaluation suggests that NPWT is unlikely to be a cost-effective strategy for improving outcomes in adult patients with severe open fractures of the lower limb. Cite this article: Bone Joint J 2019;101-B:1392–1401.
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Affiliation(s)
- S. Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - B. Parker
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - J. Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Achten
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - S. E. Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N. Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - M. L. Costa
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
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