NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.
Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
BMC Health Serv Res. 2020 Aug 31;20(1):811. doi: 10.1186/s12913-020-05682-9.
Evidence on the most effective and cost-effective management of ankle fractures is sparse but evolving. A recent large RCT in older patients with unstable fractures found that management with close-contact-casting was functionally equivalent and more cost-effective than internal fixation. We describe temporal and geographic variation in ankle fracture management and estimate the potential savings if close-contact-casting was used more often in older patients.
Patients admitted to hospital in England between 2007/08 and 2016/17 with an ankle fracture were identified using routine hospital episode statistics. We tested whether the use of internal fixation, and the proportion of internal fixations using intramedullary implants, changed over time. We estimated the potential annual cost savings if patients aged 60+ years were treated with close-contact-casting rather than internal fixation, in line with emerging evidence.
Over the 10-year period, there were 223,465 hospital admissions with a primary ankle fracture diagnosis. The incidence (per 100,000) of internal fixation was fairly consistent over time in younger (33.2 in 2007/08, 30.9 in 2016/17) and older (36.5 in 2007/08, 37.4 in 2016/17) patients. The proportion of internal fixations which used intramedullary implants increased in both age groups (17.0-19.5% < 60 years; 15.2-17.4% 60+ years). In 2016/17, the cost of inpatient hospital care for ankle fractures in England was over £63.1million. If 50% of older patients who had an internal fixation instead had close-contact-casting, we estimate that approximately £1.56million could have been saved.
Despite emerging evidence that non-surgical and surgical management achieve equivalent functional outcomes in older patients, the rate of surgical fixation has remained relatively stable over the decade. The health service could achieve substantial savings if a higher proportion of older patients were treated with close-contact-casting, in line with recent evidence.
有关踝关节骨折最有效和最具成本效益的管理的证据很少，但正在不断发展。最近一项针对不稳定骨折老年患者的大型 RCT 发现，与内固定相比，紧密接触石膏固定在功能上等效且更具成本效益。我们描述了踝关节骨折管理的时间和地理变化，并估计如果在老年患者中更频繁地使用紧密接触石膏固定，潜在的节省金额。
使用常规医院病例统计数据，确定 2007/08 年至 2016/17 年期间在英格兰住院治疗的踝关节骨折患者。我们测试了内固定的使用以及髓内植入物固定的比例是否随时间变化。我们根据新出现的证据，估计如果 60 岁以上的患者接受紧密接触石膏固定而不是内固定治疗，每年潜在的节省成本。
在 10 年期间，有 223465 例初次踝关节骨折诊断的住院治疗。在年轻患者（2007/08 年为 33.2，2016/17 年为 30.9）和老年患者（2007/08 年为 36.5，2016/17 年为 37.4）中，内固定的发生率（每 10 万人）在一段时间内相对稳定。在这两个年龄组中，使用髓内植入物的内固定比例都有所增加（<60 岁者为 17.0-19.5%；60 岁以上者为 15.2-17.4%）。2016/17 年，英格兰踝关节骨折住院治疗的医疗费用超过 6310 万英镑。如果有 50%接受内固定治疗的老年患者改为紧密接触石膏固定，我们估计可以节省约 156 万英镑。
尽管有新的证据表明非手术和手术治疗在老年患者中获得等效的功能结果，但在过去十年中，手术固定率相对稳定。如果更多的老年患者接受紧密接触石膏固定，符合最近的证据，那么医疗服务可以实现大量节省。
