肱骨近端骨折手术与非手术治疗的成本-最小化分析及治疗趋势。
Cost-Minimization Analysis and Treatment Trends of Surgical and Nonsurgical Treatment of Proximal Humerus Fractures.
机构信息
VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
出版信息
J Hand Surg Am. 2020 Aug;45(8):698-706. doi: 10.1016/j.jhsa.2020.03.022. Epub 2020 May 30.
PURPOSE
Recent evidence demonstrated similar outcomes between nonsurgical and surgical management of displaced proximal humerus fractures. We analyzed treatment trends and performed a cost-minimization analysis comparing nonsurgical treatment, open reduction and internal fixation, reverse total shoulder arthroplasty, and hemiarthroplasty. We hypothesized that rates of surgical treatment have increased and that the costs associated with surgery are greater compared with nonsurgical management of proximal humerus fractures.
METHODS
We used a US private-payer claims database of 22 million patient records from 2007 to 2016 to compare (1) cost for the episode of care from the payer perspective between each surgical group and nonsurgical treatment of proximal humerus fractures, and (2) annual trends and complication rates of each group. Cost data, including facility fees, physician fees, physical therapy, and clinic visits, were used to complete a cost-minimization analysis.
RESULTS
Nonsurgical treatment was associated with lower average total costs compared with surgical intervention. Facility and physician fees accounted for most of this difference. Physical therapy costs and number of physical therapy visits were higher in each surgical group compared with nonsurgical treatment. Surgical treatment was associated with higher complications, revision rates, and length of stay. There was a small but statistically significant decrease in nonsurgical management of proximal humerus fractures between 2007 and 2016. No change was observed in rates of open reduction and internal fixation, whereas rates of reverse total shoulder arthroplasty increased and rates of hemiarthroplasty decreased.
CONCLUSIONS
Nonsurgical management of proximal humerus fractures decreased during the study period. In the setting of treatment equipoise, cost-minimization analysis favors nonsurgical management of proximal humerus fractures. Surgical management is associated with higher complication rates, revision rates, and length of stay.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic Decision Analysis IV.
目的
最近的证据表明，对于移位的肱骨近端骨折，非手术治疗与手术治疗的结果相似。我们分析了治疗趋势，并进行了成本最小化分析，比较了非手术治疗、切开复位内固定、反式全肩关节置换和人工半肩关节置换。我们假设手术治疗的比例有所增加，并且与非手术治疗相比，手术相关的成本更高。
方法
我们使用了一个来自 2007 年至 2016 年的 2200 万患者记录的美国私人支付者索赔数据库，比较了（1）从支付者的角度来看，每个手术组与非手术治疗肱骨近端骨折的治疗期间费用，以及（2）每个组的年度趋势和并发症发生率。使用成本数据，包括设施费用、医生费用、物理治疗和就诊次数，完成了成本最小化分析。
结果
与手术干预相比，非手术治疗与较低的平均总成本相关。设施和医生费用占了大部分差异。每个手术组的物理治疗费用和物理治疗就诊次数都高于非手术治疗。手术治疗与更高的并发症、翻修率和住院时间相关。在 2007 年至 2016 年期间，非手术治疗肱骨近端骨折的比例略有下降，但有统计学意义。切开复位内固定的比例没有变化，而反式全肩关节置换的比例增加，人工半肩关节置换的比例下降。
结论
在治疗平衡的情况下，成本最小化分析支持非手术治疗肱骨近端骨折。在治疗平衡的情况下，成本最小化分析支持非手术治疗肱骨近端骨折。手术治疗与更高的并发症发生率、翻修率和住院时间相关。
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