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[并发症和合并症对肱骨近端骨折手术治疗住院时间及费用的影响]

[Influence of complications and comorbidities on length of hospital stay and costs for surgical treatment of proximal humeral fractures].

作者信息

Stolberg-Stolberg Josef, Köppe Jeanette, Rischen Robert, Freistühler Moritz, Faldum Andreas, Katthagen J Christoph, Raschke Michael J

机构信息

Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude W1, 48149, Münster, Deutschland.

Institut für Biometrie und Klinische Forschung, Westfälische Wilhelms-Universität Münster, Schmeddingstraße 56, 48149, Münster, Deutschland.

出版信息

Chirurg. 2021 Oct;92(10):907-915. doi: 10.1007/s00104-021-01491-w. Epub 2021 Sep 17.

DOI:10.1007/s00104-021-01491-w
PMID:34533598
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8463392/
Abstract

After a proximal humeral fracture in older patients, locked plate fixation and reverse total shoulder arthroplasty are two competing surgical procedures. Even if recent clinical studies indicate a functional superiority of reverse shoulder arthroplasty over locked plate fixation, health-economic comparative data are lacking in the literature. Health claims data of 55,070 patients aged 65 years or older who were treated with reverse total shoulder arthroplasty or locked plate fixation after proximal humeral fractures, were analyzed regarding length of hospital stay and costs. Multivariable linear regression models were used to analyze the influence of comorbidities and complications on the length of hospital stay and costs. The length of hospital stay after reverse total shoulder arthroplasty with 20.0 days (±13.5 days) was statistically noticeable longer compared to locked plate fixation with 14.6 days (±11.4 days, p < 0.001). The costs per case showed a clear difference with 11,165.70€ (±5884.36€) for reverse total shoulder arthroplasty and 7030.11€ (±5532.02€) for locked plate fixation (p < 0.001). Statistically noticeable cost increases due to comorbidities and complications underline the urgent need for specialized geriatric trauma centers.

摘要

在老年患者发生肱骨近端骨折后，锁定钢板固定术和反式全肩关节置换术是两种相互竞争的外科手术方式。尽管近期临床研究表明反式肩关节置换术在功能上优于锁定钢板固定术，但文献中缺乏卫生经济学方面的比较数据。我们分析了55070例65岁及以上肱骨近端骨折后接受反式全肩关节置换术或锁定钢板固定术患者的健康索赔数据，涉及住院时间和费用。采用多变量线性回归模型分析合并症和并发症对住院时间和费用的影响。反式全肩关节置换术后的住院时间为20.0天（±13.5天），与锁定钢板固定术的14.6天（±11.4天，p<0.001）相比，在统计学上显著更长。每例费用存在明显差异，反式全肩关节置换术为11165.70€（±5884.36€），锁定钢板固定术为7030.11€（±5532.02€）（p<0.001）。合并症和并发症导致的统计学上显著的费用增加凸显了建立专门的老年创伤中心迫在眉睫。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f27/8463392/184b71f015fb/104_2021_1491_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f27/8463392/184b71f015fb/104_2021_1491_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4f27/8463392/184b71f015fb/104_2021_1491_Fig1_HTML.jpg

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Perioperative Factors Affecting the Length of Hospitalization After Shoulder Arthroplasty.
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