Hayek Kevin R, Parikh Harsh R, McCreary Dylan L, Westberg Jerald R, Mirick Gudrun, Baynard Taurean, Schmidt Andrew H, Cunningham Brian P
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
Department of Orthopedics, Hennepin County Medical Center, Minneapolis, MN.
J Orthop Trauma. 2019 Nov;33 Suppl 7:S5-S10. doi: 10.1097/BOT.0000000000001620.
Rising health care expenditures and declining reimbursements have generated interest in providing interventions of value. The use of external fixation is a commonly used intermediate procedure for the staged treatment of unstable fractures. External fixator constructs can vary in design and costs based on selected component configuration. The objective of this study was to evaluate cost variation and relationships to injury and noninjury characteristics in temporizing external fixation of tibial plateau fractures. We hypothesize that construct costs are highly variable and present no noticeable patterns with both injury and noninjury characteristics.
A retrospective review of tibial plateau fractures treated with initial temporizing external fixation between 2010 and 2016 at 2 Level I trauma centers was conducted. Fracture and patient characteristics including age, body mass index, AO/OTA classification, and Schatzker fracture classification were observed with construct cost. In addition, injury-independent characteristics of surgeon education, site of procedure, and date of procedure were evaluated with construct cost. Factors associated with cost variation were assessed using nonparametric comparative and goodness-of-fit regression tests.
Two hundred twenty-one patient cases were reviewed. The mean knee spanning fixator construct cost was $4947 (95% confidence interval = $4742-$5152). The overall range in construct costs was from $1848 to $11,568. The mean duration of use was 16.4 days. No strong correlations were noted between construct cost and patient demographics (r = 0.02), fracture characteristics (r = 0.02), or injury-independent characteristics (r = 0.10). Finally, there was no significant difference between constructs of traumatologists and other orthopaedic surgeon subspecialists (P = 0.12).
Temporizing external fixation of tibial plateau is a high-cost intervention per unit of time and exhibits massive variation in the mean cost. This presents an ideal opportunity for cost savings by reducing excessive variation in implant component selection.
Level III. Retrospective Cohort.
不断上涨的医疗保健支出和不断下降的报销费用引发了人们对提供有价值干预措施的兴趣。外固定的使用是不稳定骨折分期治疗中常用的中间程序。基于所选组件配置，外固定器结构在设计和成本上可能会有所不同。本研究的目的是评估胫骨平台骨折临时外固定的成本差异以及与损伤和非损伤特征的关系。我们假设结构成本高度可变，并且在损伤和非损伤特征方面没有明显模式。
对2010年至2016年期间在2个一级创伤中心接受初始临时外固定治疗的胫骨平台骨折进行回顾性研究。观察骨折和患者特征，包括年龄、体重指数、AO/OTA分类和Schatzker骨折分类，并记录结构成本。此外，评估与结构成本相关的医生教育、手术部位和手术日期等与损伤无关的特征。使用非参数比较和拟合优度回归测试评估与成本差异相关的因素。
共回顾了221例患者病例。平均跨膝关节固定器结构成本为4947美元（95%置信区间 = 4742美元至5152美元）。结构成本的总体范围为1848美元至11568美元。平均使用时间为16.4天。在结构成本与患者人口统计学特征（r = 0.02）、骨折特征（r = 0.02）或与损伤无关的特征（r = 0.10）之间未发现强相关性。最后，创伤科医生和其他骨科亚专科医生使用的结构之间没有显著差异（P = 0.12）。
胫骨平台临时外固定是一种单位时间成本较高的干预措施，平均成本存在巨大差异。这为通过减少植入物组件选择的过度差异来节省成本提供了理想机会。
三级。回顾性队列研究。
