Rosas Samuel, Gwam Chukwuweike U, Araiza Edgar T, Roche Martin W, Emory Cynthia L, Carroll Eben A, Halvorson Jason J, Plate Johannes F
Department of Orthopedic Surgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA.
Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
Ann Transl Med. 2021 Feb;9(3):210. doi: 10.21037/atm-20-1064.
The purpose of this study was to perform an epidemiological evaluation and an economic analysis of 90-day costs associated with non-fatal gunshot wounds (GSWs) to the extremities, spine and pelvis requiring orthopaedic care in the United States.
A retrospective epidemiological review of the Medicare national patient record database was conducted from 2005 to 2014. Incidence, fracture location and costs associated where evaluated. Those patients identified through International Classification of Disease (ICD)-9 revision codes and Current Procedural Terminology (CPT) Codes who sustained a fracture secondary to a GSW. Any type of surgical intervention including incision and drainage, open reduction with internal fixation, closed reduction and percutaneous fixation, etc. were identified to analyze, and evaluate costs of care as seen by charges and reimbursements to the payer. The 90-day period after initial fracture care was queried.
A total of 9,765 patients required surgical orthopaedic care for GSWs. There was a total of 2,183 fractures due to GSW treated operatively in 2,201 patients. Of these, 22% were femur fractures, 18.3% were hand/wrist fractures and 16.7% were ankle/foot fractures. A majority of patients were male (83.3%) and under 65 years of age (56.3%). Total charges for GSW requiring orthopedic care were $513,334,743 during the 10-year study period. Total reimbursement for these patients were $124,723,068. Average charges per patient were highest for fracture management of the spine $431,021.33, followed by the pelvis $392,658.45 and later by tibia/fibula fractures $342,316.92.
The 90-day direct charges and reimbursements of orthopedic care for non-fatal GSWs are of significant amounts per patient. While the number of fatal GSWs has received much attention, non-fatal GSWs have a large economic and societal impact that warrants further research and consideration by the public and policy makers.
本研究旨在对美国因非致命性枪伤导致四肢、脊柱和骨盆骨折并需要骨科治疗的90天费用进行流行病学评估和经济分析。
对2005年至2014年医疗保险全国患者记录数据库进行回顾性流行病学审查。评估发病率、骨折部位及相关费用。通过国际疾病分类（ICD）-9修订码和现行手术操作术语（CPT）码确定那些因枪伤继发骨折的患者。识别包括切开引流、切开复位内固定、闭合复位和经皮固定等任何类型的手术干预措施，以分析并评估支付方所收取费用和报销费用体现的护理成本。查询初次骨折护理后的90天期间。
共有9765例患者因枪伤需要骨科手术治疗。2201例患者中共有2183处因枪伤导致的骨折接受了手术治疗。其中，22%为股骨骨折，18.3%为手部/腕部骨折，16.7%为踝部/足部骨折。大多数患者为男性（83.3%）且年龄在65岁以下（56.3%）。在10年研究期间，因枪伤需要骨科护理的总费用为513334743美元。这些患者的总报销费用为124723068美元。每位患者平均费用最高的是脊柱骨折治疗，为431021.33美元，其次是骨盆骨折为392658.45美元，然后是胫腓骨骨折为342316.92美元。
非致命性枪伤骨科护理的90天直接费用和报销费用对每位患者来说数额巨大。虽然致命性枪伤的数量备受关注，但非致命性枪伤具有巨大的经济和社会影响，值得公众和政策制定者进一步研究和考虑。
