Department of Epidemiology and Preventive Medicine, Monash University, Melbourne VIC 3004, Australia.
Department of Orthopaedic Surgery, Alfred Hospital, Melbourne VIC 3004, Australia.
Int J Environ Res Public Health. 2018 Dec 13;15(12):2845. doi: 10.3390/ijerph15122845.
Fracture healing complications are common and result in significant healthcare burden. The aim of this study was to determine the rate, costs and predictors of two-year readmission for surgical management of healing complications (delayed, mal, non-union) following fracture of the humerus, tibia or femur. Humeral, tibial and femoral (excluding proximal) fractures registered by the Victorian Orthopaedic Trauma Outcomes Registry over five years ( = 3962) were linked with population-level hospital admissions data to identify two-year readmissions for delayed, mal or non-union. Study outcomes included hospital length-of-stay (LOS) and inpatient costs. Multivariable logistic regression was used to determine demographic and injury-related factors associated with admission for fracture healing complications. Of the 3886 patients linked, 8.1% were readmitted for healing complications within two years post-fracture, with non-union the most common complication and higher rates for femoral and tibial shaft fractures. Admissions for fracture healing complications incurred total costs of $4.9 million AUD, with a median LOS of two days. After adjusting for confounders, patients had higher odds of developing complications if they were older, receiving compensation or had tibial or femoral shaft fractures. Patients who are older, with tibial and femoral shaft fractures should be targeted for future research aimed at preventing complications.
骨折愈合并发症较为常见,会导致巨大的医疗保健负担。本研究旨在确定肱骨干、胫骨或股骨干骨折患者在两年内因愈合并发症(延迟愈合、畸形愈合、不愈合)接受手术治疗的再入院率、费用及预测因素。维多利亚州创伤骨科结局登记处(Victorian Orthopaedic Trauma Outcomes Registry)五年内(n=3962)登记的肱骨干、胫骨骨干和股骨骨干(不包括近端)骨折病例与人群水平的住院数据相关联,以确定因延迟愈合、畸形愈合或不愈合而在两年内再次入院的病例。研究结局包括住院时间(Length-of-Stay,LOS)和住院费用。采用多变量逻辑回归分析确定与骨折愈合并发症入院相关的人口统计学和损伤相关因素。在 3886 例可关联的患者中,8.1%的患者在骨折后两年内因愈合并发症再次入院,其中不愈合最常见,股骨干和胫骨骨干骨折的发生率更高。骨折愈合并发症的住院总费用为 490 万澳元(AUD),中位 LOS 为 2 天。在调整混杂因素后,年龄较大、接受赔偿或患有股骨干和胫骨骨干骨折的患者发生并发症的可能性更高。对于年龄较大、患有胫骨和股骨干骨折的患者,应将其作为未来预防并发症研究的目标人群。
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