David Lisa R, Bisseck Marc, Defranzo Anthony, Marks Malcolm, Molnar Joseph, Argenta Louis C
Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1075, USA.
J Trauma. 2003 Sep;55(3):514-7. doi: 10.1097/01.TA.0000025319.71666.2D.
The objective of this study was to assess the cost effectiveness of alternative treatment algorithms for the management of isolated mandibular fractures.
This is an institutional review board-approved retrospective study consisting of a chart review of 25 patients who underwent operative repair of an isolated mandible fracture between July 1, 1999, and June 30, 2000. Patients were stratified into two groups: patients who were immediately admitted to the hospital from the emergency department (ED) versus patients who were discharged from the ED and who returned for elective scheduled operative repair. Patients' total hospital charges were compared on the basis of operating room (OR) time, operative materials, and hospital charges.
Seventeen of the study patients were directly admitted from the ED, and eight underwent elective scheduled operative repair. Of the patients directly admitted from the ED, the mean age was 34.9 years (range, 19-57 years), and the study population consisted of 16 men and 1 woman. This group had a mean OR time of 161 minutes, a mean OR time charge of $1,978.66, a mean OR supply charge of 1,049.43 US dollars, a mean hospital floor charge of 5,041.02 US dollars, and an average hospital stay of 2.82 days. The treatment group of patients undergoing scheduled operative repair (n = 8) had a mean age of 30.3 years (range, 19-49 years), and all were men. This second treatment group had a mean OR time of 167.1 minutes, a mean OR time charge of 2,162.03 US dollars, a mean OR supply charge of 871.00 US dollars, a mean hospital floor charge of 2,759.38 US dollars, and a mean hospital stay of 0.88 days. Comparison of the two study groups demonstrated operative charges were made on the basis of time and materials and were shown to have no statistically significant difference (p = 0.753 and p = 0.289, respectively). Comparison of hospital charges revealed that patients admitted directly from the ED had a mean charge 2,276.70 US dollars higher (p = 0.019) and stayed 1.95 days longer in the hospital than patients discharged from the emergency department who returned for elective scheduled repair. There were two complications in the study patients; both occurred in the group admitted directly from the emergency room.
The results of this study indicate that the most cost-effective management of an isolated mandibular fracture is initial evaluation in the ED with elective interval operative repair. This management protocol is, of course, only applicable if the patient is clinically stable and has no other injuries or comorbidities necessitating in-hospital observation.
本研究的目的是评估用于治疗孤立性下颌骨骨折的替代治疗方案的成本效益。
这是一项经机构审查委员会批准的回顾性研究，对1999年7月1日至2000年6月30日期间接受孤立性下颌骨骨折手术修复的25例患者的病历进行了回顾。患者被分为两组：从急诊科直接入院的患者与从急诊科出院后返回进行择期手术修复的患者。根据手术室（OR）时间、手术材料和住院费用对患者的总住院费用进行比较。
17例研究患者从急诊科直接入院，8例接受择期手术修复。从急诊科直接入院的患者中，平均年龄为34.9岁（范围19 - 57岁），研究人群包括16名男性和1名女性。该组的平均手术室时间为161分钟，平均手术室时间费用为1,978.66美元，平均手术室耗材费用为1,049.43美元，平均病房费用为5,041.02美元，平均住院时间为2.82天。接受择期手术修复的治疗组患者（n = 8）平均年龄为30.3岁（范围19 - 49岁），均为男性。第二个治疗组的平均手术室时间为167.1分钟，平均手术室时间费用为2,162.03美元，平均手术室耗材费用为871.00美元，平均病房费用为2,759.38美元，平均住院时间为0.88天。两个研究组的比较表明，手术费用基于时间和材料，且无统计学显著差异（分别为p = 0.753和p = 0.289）。住院费用比较显示，从急诊科直接入院的患者平均费用比从急诊科出院后返回进行择期手术修复的患者高2,276.70美元（p = 0.019），住院时间长1.95天。研究患者中有两例并发症；均发生在从急诊科直接入院的组中。
本研究结果表明，孤立性下颌骨骨折最具成本效益的管理方式是在急诊科进行初步评估并进行择期间隔手术修复。当然，这种管理方案仅适用于临床稳定且无其他需要住院观察的损伤或合并症的患者。
