Holmberg S, Thorngren K G
Department of Orthopedics, University Hospital, Danderyd, Sweden.
Acta Orthop Scand. 1988 Aug;59(4):377-81. doi: 10.3109/17453678809149385.
In 1,673 patients with femoral neck fracture, the utilization of hospital and rehabilitation resources following primary operations and necessary reoperations was assessed in relation to type of treatment center and outcome of the fracture. All the patients were admitted from their homes to either orthopedic or general surgery departments, urban or rural. The fractures were treated by one of four osteosynthesis methods and followed for 6 years postoperatively. About 30 per cent of the fractures developed healing complications. Patients treated in surgical departments utilized more acute and rehabilitation bed days than those treated in orthopedic departments. The patients stayed longer in city surgical departments than in rural surgical departments. The Thornton osteosynthesis used by general surgical specialists resulted in 29 percent, mainly early complications, whereas the Rydell osteosynthesis used by orthopedic specialists had 24 percent, mainly late complications. This difference resulted in more than 40 percent higher consumption of bed days by the Thornton-nailed patient. In sum, a fracture without complications consumed, on an average, 31 cost standardized bed days compared with 101 bed days for fracture with complications. Thus, every fracture with complications was SEK 112,000 more expensive than the complication-free one.
在1673例股骨颈骨折患者中，针对治疗中心类型和骨折预后，评估了初次手术及必要的再次手术后医院和康复资源的利用情况。所有患者均从家中入院，入住城市或农村的骨科或普通外科科室。骨折采用四种接骨术方法之一进行治疗，并在术后随访6年。约30%的骨折出现愈合并发症。在外科科室接受治疗的患者比在骨科科室接受治疗的患者使用更多的急性和康复病床日。患者在城市外科科室的住院时间比在农村外科科室的长。普通外科专家采用的桑顿接骨术导致29%的并发症，主要是早期并发症，而骨科专家采用的吕德尔接骨术有24%的并发症，主要是晚期并发症。这种差异导致采用桑顿钉固定的患者病床日消耗高出40%以上。总体而言，无并发症的骨折平均消耗31个成本标准化病床日，而有并发症的骨折为101个病床日。因此，每例有并发症的骨折比无并发症的骨折贵112,000瑞典克朗。
