Sprague Sheila, Bhandari Mohit
Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Sciences Centre, Room 2C12, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
Arch Orthop Trauma Surg. 2002 Jul;122(6):315-23. doi: 10.1007/s00402-001-0358-3. Epub 2001 Dec 12.
There are few reports examining the effect of surgical delay on outcomes following operative treatment of lower extremity fractures. Delays in the surgery for closed tibial shaft fractures have been reported to increase the overall complication rate, postoperative hospital stays and crude costs to the health care system. Our purpose was to estimate the cost-effectiveness and cost-utility associated with the adoption of a programme of early operative treatment of all closed tibial shaft fractures. We performed cost analyses based upon data obtained from an observational study. A cohort of patients with closed tibial shaft fractures was identified at a university-affiliated level I trauma centre. Patients were divided into an early surgical group (within 12 h) and delayed surgical group (longer than 12 h). Study outcomes included time to fracture union (weeks), direct inpatient and outpatient costs associated with each intervention, loss of productivity costs, and utilities (patient health perception) as determined from content experts. Sixteen patients were operated on within 12 h of injury and 19 patients were treated later than 12 h after their fracture. These groups were similar for all baseline variables. The average time to fracture union was 28.2 weeks (SD 9.4) and 44.2 weeks (SD 7.4) for the early surgical group and the delayed surgical group, respectively ( p<0.01). When the costs associated with productivity losses were included in the cost-effectiveness analysis, savings were noted of 7,330 CD dollars per patient and of 458 CD dollars for each week that a fracture healed more quickly with early treatment. However, when the loss of patient productivity was not included, there was a cost per week of 67 CD dollars. A difference of 0.09 quality adjusted life years (QALYs) in favour of the early surgery was found, which yielded a savings of 81,444 CD dollars per QALY gained when the productivity losses were included and a cost per QALY of 11,922 CD dollars when the productivity losses were not included. Both cost-effectiveness and cost-utility analyses were robust. Early plate fixation of closed tibial shaft fractures results in significantly shorter time to fracture union, fewer postoperative complications, significant cost effectiveness and greater QALYs gained when compared with delayed treatment. Inferences from this study are strengthened by the comprehensive abstraction of cost data and detailed cost-effectiveness and cost-utility analyses.
很少有报告研究手术延迟对下肢骨折手术治疗效果的影响。据报道，闭合性胫骨干骨折手术延迟会增加总体并发症发生率、术后住院时间以及医疗系统的总体费用。我们的目的是评估采用早期手术治疗所有闭合性胫骨干骨折方案的成本效益和成本效用。我们基于从一项观察性研究中获得的数据进行了成本分析。在一所大学附属的一级创伤中心确定了一组闭合性胫骨干骨折患者。患者被分为早期手术组（12小时内）和延迟手术组（超过12小时）。研究结果包括骨折愈合时间（周）、与每种干预相关的直接住院和门诊费用、生产力损失成本以及由内容专家确定的效用（患者健康感知）。16例患者在受伤后12小时内接受手术，19例患者在骨折后12小时后接受治疗。这两组在所有基线变量方面相似。早期手术组和延迟手术组的平均骨折愈合时间分别为28.2周（标准差9.4）和44.2周（标准差7.4）（p<0.01）。当将与生产力损失相关的成本纳入成本效益分析时，发现每位患者节省7330加元，且早期治疗使骨折愈合更快的情况下，每周节省458加元。然而，当不包括患者生产力损失时，每周成本为67加元。发现早期手术在质量调整生命年（QALY）方面有0.09的优势，当纳入生产力损失时，每获得一个QALY节省81444加元，不包括生产力损失时，每个QALY成本为11922加元。成本效益分析和成本效用分析都很可靠。与延迟治疗相比，闭合性胫骨干骨折早期钢板固定可显著缩短骨折愈合时间，减少术后并发症，具有显著的成本效益并能获得更多的QALY。本研究通过对成本数据的全面提取以及详细的成本效益和成本效用分析，增强了研究推断的可信度。
