Department of Orthopaedic Surgery, The University of Texas at Austin, Austin, TX, USA.
Department of Orthopaedic Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Injury. 2022 Aug;53(8):2872-2879. doi: 10.1016/j.injury.2022.06.016. Epub 2022 Jun 14.
External fixator costs have been shown to be highly variable. Current information on external fixator costs and cost drivers is limited. The aim of this study was to examine the cost variation as well as the patient-, injury-, and surgeon-related cost drivers associated with temporizing external fixation constructs in tibial plateau and pilon fracture management.
A retrospective review was conducted to identify isolated tibial plateau and pilon fractures treated with temporizing external fixation from 2006-2018 at a level 1 trauma center. Inclusion criteria were based on fractures managed with primary external fixation, skeletal maturity, and isolated ipsilateral fracture fixation. Fracture patterns were identified radiographically using Schatzker, Weber, and OTA classification systems. Implant costs were determined using direct purchase price from the institution. The primary outcome was the external fixator total construct cost. Clinical covariates and secondary outcomes, namely unplanned reoperations, were extracted. Factors associated with cost (i.e. cost drivers) were identified via multivariable regression analysis.
A total of 319 patients were included in this study (121 tibial plateau and 198 pilon fractures). Mean plateau construct cost was $5,372.12 and mean pilon construct cost was $3,938.97. Implant cost correlated poorly with demographic (r=0.01 & r=0.01), injury-independent (r<0.01 & r=0.03), and fracture pattern classifications (r=0.03 & r=0.02). Traumatologists produced significantly cheaper implants for pilon fractures (p=0.05) but not for plateau fractures (p=0.85). There was no difference in construct cost or components between patients that underwent unplanned reoperation and those that did not for both tibial plateau (p>0.19) and pilon (p>0.06). Clamps contributed to 69.9% and 77.3% of construct costs for tibial plateau and pilon, respectively. The most cost-efficient fixation constructs for tibial plateau and pilon fractures were the following respectively: of 5 clamps, 2 bars, and 4 pins; and of 4 clamps, 2 bars, and 3 pins.
There is large cost variation in temporizing external fixation management. Cost drivers included surgeon bias and implant preference as well as use of external fixator clamps. Introducing construct standardization will contain healthcare spending without sacrificing patient outcomes.
Level III. Retrospective Cohort.
已经证明，外固定器的成本存在很大的差异。目前关于外固定器成本和成本驱动因素的信息有限。本研究的目的是检查胫骨平台和 Pilon 骨折管理中外固定临时固定的成本变化以及与患者、损伤和外科医生相关的成本驱动因素。
对 2006 年至 2018 年在 1 级创伤中心接受临时外固定治疗的孤立性胫骨平台和 Pilon 骨折患者进行回顾性分析。纳入标准为：采用初次外固定治疗、骨骼成熟度和同侧骨折固定的胫骨平台和 Pilon 骨折。骨折模式通过 Schatzker、Weber 和 OTA 分类系统进行放射学评估。使用机构的直接采购价格确定植入物成本。主要结果是外固定器总构建成本。提取了临床协变量和次要结果（即计划外再手术）。通过多元回归分析确定与成本相关的因素（即成本驱动因素）。
本研究共纳入 319 例患者（胫骨平台 121 例，Pilon 骨折 198 例）。平均平台构建成本为 5372.12 美元，平均 Pilon 构建成本为 3938.97 美元。植入物成本与人口统计学因素（r=0.01 和 r=0.01）、与损伤无关的因素（r<0.01 和 r=0.03）以及骨折模式分类（r=0.03 和 r=0.02）相关性较差。创伤外科医生为 Pilon 骨折制造的植入物明显更便宜（p=0.05），但不是胫骨平台骨折（p=0.85）。对于胫骨平台（p>0.19）和 Pilon 骨折（p>0.06），计划外再手术患者和未行计划外再手术患者的构建成本或组件没有差异。夹钳分别占胫骨平台和 Pilon 外固定器构建成本的 69.9%和 77.3%。胫骨平台和 Pilon 骨折最具成本效益的固定结构分别为：5 个夹钳、2 个杆和 4 个销；4 个夹钳、2 个杆和 3 个销。
临时外固定治疗的成本存在很大差异。成本驱动因素包括外科医生的偏见和植入物偏好以及外固定器夹钳的使用。引入构建标准化将在不影响患者预后的情况下控制医疗保健支出。
三级。回顾性队列。
