Comadoll Shea M, Landry Jarvis D, Yancey Hunter B, Graves Benjamin R
Department of Orthopaedic Surgery, Wake Forest Baptist Hospital, Winston Salem, NC, USA.
JSES Int. 2020 Jun 6;4(3):584-586. doi: 10.1016/j.jseint.2020.04.023. eCollection 2020 Sep.
Shoulder dislocation is a costly problem and can have a high risk for recurrent instability after initial dislocation based on well-defined patient characteristics. Patients with recurrent instability can be treated with shoulder stabilizing procedures. Although more costly, surgery may decrease the overall health care burden of managing a patient with multiple shoulder dislocations nonoperatively.
We performed a retrospective chart review of all patients who presented to the emergency department (ED) with a diagnosis of a shoulder dislocation at a level 1 academic trauma center during the year 2016. Patient information regarding the current dislocation episode, previous dislocations, shoulder surgeries, and postreduction follow-up was gathered. These data were then used to determine the average cost of an ED presentation for a shoulder dislocation episode as obtained from the hospital finance department. The average cost of shoulder stabilization surgery was used to conduct a cost-benefit analysis of operative vs. nonoperative management.
Data were collected on 104 individuals who presented to the ED with shoulder dislocations. Of these, 65 were primary dislocations and 39 were recurrent dislocations. Twelve patients underwent shoulder stabilization surgery after their ED presentation. The average cost to the institution for an ED visit requiring the closed reduction of a shoulder dislocation was $2207 ($973.21 without sedation and $3744 with conscious sedation). The average cost of a shoulder stabilization procedure performed at this same institution was $7807.
Although shoulder stabilization has a higher cost on the front end, this intervention results in cost savings if it prevents 2-3 future shoulder dislocations resulting in ED visits. These findings suggest that, for patients with a high risk for recurrent instability, not only would stabilization surgery help prevent subsequent dislocation events but would also minimize health care costs.
肩关节脱位是一个代价高昂的问题，根据明确的患者特征，初次脱位后复发不稳定的风险可能很高。复发性不稳定的患者可通过肩关节稳定手术进行治疗。虽然手术费用更高，但可能会降低对多次非手术治疗肩关节脱位患者进行整体医疗管理的负担。
我们对2016年在一级学术创伤中心急诊科就诊且诊断为肩关节脱位的所有患者进行了回顾性病历审查。收集了有关当前脱位发作、既往脱位、肩部手术以及复位后随访的患者信息。然后利用这些数据确定从医院财务部门获得的肩关节脱位发作急诊就诊的平均费用。使用肩关节稳定手术的平均费用对手术治疗与非手术治疗进行成本效益分析。
收集了104例到急诊科就诊的肩关节脱位患者的数据。其中，65例为初次脱位，39例为复发性脱位。12例患者在急诊科就诊后接受了肩关节稳定手术。该机构对需要闭合复位肩关节脱位的急诊就诊的平均费用为2207美元（无镇静时为973.21美元，清醒镇静时为3744美元）。同一机构进行的肩关节稳定手术的平均费用为7807美元。
虽然肩关节稳定手术前期成本较高，但如果能预防未来2至3次导致急诊就诊的肩关节脱位，这种干预措施会节省成本。这些研究结果表明，对于复发性不稳定风险较高的患者，稳定手术不仅有助于预防后续脱位事件，还能将医疗成本降至最低。
