Malawi-Liverpool-Wellcome; University of Warwick Medical School.
University of Warwick Medical School; University Hospitals Coventry and Warwickshire.
Injury. 2021 Jun;52(6):1251-1259. doi: 10.1016/j.injury.2021.02.022. Epub 2021 Feb 14.
Open tibia fractures are a common injury following road traffic collisions and place a large economic burden on patients and healthcare systems. Summarising their economic burden is key to inform policy and help prioritise treatment.
All studies were identified from a systematic search of Medline, Embase and the Cochrane Central Register of Controlled Trials. We included any human with a diagnosed open tibia fracture, following any intervention. The primary outcome was any costs reported or patient return to work status. Secondary outcomes included average length of stay, wage loss, absenteeism and complications such as infection, amputation and nonunion. Data was extracted and we performed a descriptive narrative summary.
We reviewed 1,204 studies from our searches. A total of 34 studies were included from 14 different countries. The average age was 37.7 years old and 76% of the patients were male. 6.5% were Gustilo I, 12% Gustilo II and 82% Gustilo III. Initial direct hospitalisation costs were reported to be between £356 to £126,479 with an average length of stay of 56 days (3.1-244). 89% of participants were working pre-injury, 60% fully returned to work, 17% returned to work part time or changed profession and 22% did not return to work at one-year. The most common complications reported were 22% infection, 11% nonunion and 16% amputation. Mean follow-up duration for the studies was 25 months.
The economic burden of open tibia fractures varies greatly, but it is costly for both hospitals and patients. The current evidence is predominantly from high-income countries (HICs), especially the USA. Further research is required to investigate the costs of open tibia fractures using validated costing tools, especially in low-income countries (LICs), to help inform and direct policy.
开放性胫骨骨折是道路交通事故后的常见损伤，给患者和医疗系统带来了巨大的经济负担。总结其经济负担对于制定政策和帮助确定治疗优先级至关重要。
通过对 Medline、Embase 和 Cochrane 对照试验中心注册库的系统搜索，确定了所有研究。我们纳入了任何诊断为开放性胫骨骨折的人类患者，无论干预措施如何。主要结局是报告的任何费用或患者重返工作岗位的情况。次要结局包括平均住院时间、工资损失、旷工以及感染、截肢和骨折不愈合等并发症。提取数据并进行描述性叙述总结。
我们从检索中审查了 1204 项研究。从 14 个不同的国家共纳入了 34 项研究。平均年龄为 37.7 岁，76%的患者为男性。6.5%为 Gustilo I 型，12%为 Gustilo II 型，82%为 Gustilo III 型。报告的初始直接住院费用介于 356 英镑至 126479 英镑之间，平均住院时间为 56 天（3.1-244 天）。89%的参与者在受伤前有工作，60%完全重返工作岗位，17%兼职或改行，22%在一年后无法重返工作岗位。报告的最常见并发症是 22%的感染、11%的骨折不愈合和 16%的截肢。研究的平均随访时间为 25 个月。
开放性胫骨骨折的经济负担差异很大，但对医院和患者来说都是昂贵的。目前的证据主要来自高收入国家（HICs），特别是美国。需要进一步研究使用经过验证的成本核算工具来调查开放性胫骨骨折的成本，特别是在低收入国家（LICs），以帮助为政策制定提供信息和指导。
