Kadakia Rishin J, Ahearn Briggs M, Tenenbaum Shay, Bariteau Jason T
Department of Orthopaedics, Emory University, Atlanta, Georgia (RJK, BMA, JTB).
Chaim Sheba Medical Center Department of Orthopaedic Surgery, Ramat Gan, Israel (ST).
Foot Ankle Spec. 2017 Feb;10(1):26-30. doi: 10.1177/1938640016666919. Epub 2016 Sep 20.
Ankle fractures are the third most common orthopaedic injury seen in the geriatric patient. Studies have identified mortality benefits with operative management, but treatment must be considered on a case-by-case basis. In the era of value-based analysis, a thorough of understanding of outcomes and costs of treatment is required. The purpose of this study was to analyze the inpatient and readmission costs associated with operative and nonoperative management of geriatric ankle fractures.
Patients were identified using diagnosis codes for ankle fractures from all 2008 Part A Medicare claims. Patients younger than 65 years and those who sustained an ankle fracture during the previous year were excluded. Operative patients were then identified by ICD-9 procedure codes. Other variables collected included age, comorbidities, and the incidence of hospital readmissions. Inpatient costs were determined using Medicare reimbursement data.
A total of 19 648 patients with ankle fractures were identified. Of these, 15 193 (77.3%) underwent operative intervention. The mean cost for initial fracture admission was $5097.20 for nonoperative management compared with $8798.10 for operative management ( P < .05). The mean inpatient costs associated with readmission for nonoperative intervention was $5161.50 and for operative treatment, it was $5071.40 ( P > .05). The reimbursement for hospital readmissions for both groups combined for approximately $29.7 million. The total cost of initial treatment plus readmission for both treatment groups combined was approximately $185 million.
The total expenditure estimate of $185 million in this study has likely increased given the steady growth of the geriatric population. Expenditures associated with these readmissions was approximately $30 million-nearly a sixth of total costs. Future work must focus on determining which patients will benefit from operative intervention and optimizing care to decrease readmissions and their associated cost in this growing cohort of patients.
Therapeutic, Level III: Retrospective study.
踝关节骨折是老年患者中第三常见的骨科损伤。研究已确定手术治疗具有降低死亡率的益处，但治疗必须根据具体情况进行考虑。在基于价值分析的时代，需要全面了解治疗结果和成本。本研究的目的是分析老年踝关节骨折手术治疗和非手术治疗的住院费用及再入院费用。
通过2008年所有A部分医疗保险索赔中的踝关节骨折诊断代码识别患者。排除年龄小于65岁以及前一年发生过踝关节骨折的患者。然后通过ICD - 9手术代码识别接受手术治疗的患者。收集的其他变量包括年龄、合并症和医院再入院率。使用医疗保险报销数据确定住院费用。
共识别出19648例踝关节骨折患者。其中，15193例（77.3%）接受了手术干预。非手术治疗的初次骨折入院平均费用为5097.20美元，而手术治疗为8798.10美元（P <.05）。非手术干预再入院的平均住院费用为5161.50美元，手术治疗为5071.40美元（P >.05）。两组医院再入院的报销费用总计约2970万美元。两个治疗组初次治疗加再入院的总费用约为1.85亿美元。
鉴于老年人口的稳步增长，本研究中1.85亿美元的总支出估计可能有所增加。与这些再入院相关的支出约为3000万美元，几乎占总成本的六分之一。未来的工作必须集中在确定哪些患者将从手术干预中受益，并优化护理以减少这一不断增长的患者群体中的再入院率及其相关成本。
治疗性，III级：回顾性研究。
