Trauma Training Center, Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY.
J Bone Joint Surg Am. 2020 Dec 16;102(24):2166-2173. doi: 10.2106/JBJS.20.00539.
The quantification of the costs of ankle fractures and their associated treatments has garnered increased attention in orthopaedics through cost-effectiveness analysis. The purpose of this study was to prospectively assess the direct and indirect costs of ankle fractures in operatively and nonoperatively treated patients.
A prospective, observational, single-center study was performed. Adult patients presenting for an initial consult for an ankle fracture were enrolled and were followed until recurring indirect costs amounted to zero. Patients completed a cost form at every visit that assessed time away from work and the money spent in the last week on transportation, household chores, and self-care due to an ankle fracture. Direct cost data were obtained directly from the hospital billing department.
Sixty patients were included in this study. With regard to patient characteristics, the mean patient age was 46.5 years, 55% of patients were female, 10% of patients had diabetes, and 17% of patients were active smokers. Weber A fractures composed 12% of fractures, Weber B fractures composed 72% of fractures, and Weber C fractures composed 18% of fractures. Operatively treated patients (n = 37) had significantly higher total costs and direct costs compared with nonoperatively treated patients (p < 0.01). In all patients, losses from missed work accounted for the largest portion of total and indirect costs, with a mean percentage of 35.8% of the total cost. The mean period preceding return to work of the 39 employed patients was 11.2 weeks. Longer periods of return to work were significantly associated with surgical fixation and having less than a college-level education (p < 0.05). The mean time for recurring observed costs to cease was 19.1 weeks.
In patients treated operatively and nonoperatively, the largest discrete cost component was a specific indirect cost. Indirect costs accounted for a mean of 41.3% of the total cost. Although the majority of the direct costs of ankle fractures are accrued in the period immediately following the injury, indirect cost components will regularly be incurred for nearly 5 months and often longer. To capture the full economic impact of these injuries, future research should include detailed reporting on an intervention's impact on the indirect costs of ankle fractures.
Economic Level III. See Instructions for Authors for a complete description of levels of evidence.
通过成本效益分析，骨科领域越来越关注踝关节骨折及其相关治疗的成本量化。本研究的目的是前瞻性评估手术和非手术治疗的踝关节骨折患者的直接和间接成本。
进行了一项前瞻性、观察性、单中心研究。招募因踝关节骨折初次就诊的成年患者，并随访至再次发生的间接成本降为零。患者在每次就诊时填写一份费用表，评估因踝关节骨折而缺勤的时间以及过去一周在交通、家务和自理方面的花费。直接成本数据直接从医院计费部门获得。
本研究共纳入 60 例患者。就患者特征而言，平均患者年龄为 46.5 岁，55%的患者为女性，10%的患者患有糖尿病，17%的患者为吸烟者。Weber A 型骨折占 12%，Weber B 型骨折占 72%，Weber C 型骨折占 18%。手术治疗患者（n=37）的总费用和直接费用明显高于非手术治疗患者（p<0.01）。在所有患者中，因缺勤导致的损失占总费用和间接费用的最大部分，占总费用的平均百分比为 35.8%。39 名在职患者恢复工作前的平均时间为 11.2 周。较长的恢复工作时间与手术固定和受教育程度低于大学水平显著相关（p<0.05）。观察到的重复成本停止的平均时间为 19.1 周。
在手术和非手术治疗的患者中，最大的离散成本构成部分是特定的间接成本。间接成本占总费用的平均 41.3%。尽管踝关节骨折的大部分直接成本发生在受伤后的即刻，但间接成本构成部分将在近 5 个月内定期发生，而且往往更长。为了全面评估这些损伤的经济影响，未来的研究应详细报告干预措施对踝关节骨折间接成本的影响。
经济等级 III。有关证据等级的完整说明，请参见作者须知。
