Counting the costs of major trauma in a provincial trauma centre.

AIMS

Trauma is an important cause of morbidity and mortality in New Zealand, and also represents a significant financial and resource burden on the healthcare system. Understanding local costs and factors that affect them is important for planning of trauma services and obtaining funding for quality improvement projects. The aim of this study was to assess actual costs and influencing factors in patients treated for major trauma in Northland, New Zealand.

METHODS

Adult patients admitted to Whangarei Hospital suffering from major trauma for three years from 1 January 2015 to 31 December 2017 were identified from the hospital's prospectively maintained trauma database. Major trauma was defined as an Injury Severity Score (ISS)>12, admission to intensive care or death secondary to trauma. Patients >50 years old with isolated neck of femur fractures, hangings, poisonings and drownings were excluded. Immediate or early (<24hours) transfers to tertiary hospitals were excluded from costing analysis. Actual costs were calculated using in-house, patient-level costing utilising CostPro software. Case-weight costs, based on DRG codes used nationally, were also calculated using standard techniques. Factors affecting costs were analysed.

RESULTS

Two hundred and sixty-one patients suffering from major trauma were identified, 62 patients were transferred early leaving 199 patients for analysis. The mean ISS was 18 (IQR=14-22) and average length of stay was 8.5 days. Fifty-one percent of the cohort required intensive care and 36% underwent operative intervention in Whangarei Hospital. Total actual cost was NZ$4,614,652 with an average cost of NZ$23,189 per patient. There was a significant difference in actual vs case-weight cost for the patients in the ISS 13-24 group who formed the bulk of the cohort. There was also extremely significant difference between the costs for patients requiring either intensive care or operative intervention versus those who did not (p=0.0001).

CONCLUSIONS

This is the first study in New Zealand describing actual costs in patients suffering from major trauma and variation to case-weight costs. Intensive care admission and operative intervention have been identified as the two main drivers of cost. Further studies are needed in New Zealand, particularly in major trauma centres, to better understand the true cost of major trauma within the country.