Welch Jessica M, Zhuang Thompson, Shapiro Lauren M, Gardner Michael J, Xiao Michelle, Kamal Robin N
VOICES Health Policy Research Center, Stanford University, Department of Orthopaedic Surgery, Redwood City, CA.
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.
Curr Orthop Pract. 2022 Nov-Dec;33(6):559-564. doi: 10.1097/bco.0000000000001167. Epub 2022 Sep 15.
Operative treatment of olecranon fractures in the elderly can lead to greater complications with similar outcomes to nonoperative treatment. The purpose of this study was to analyze cost differences between operative and nonoperative management of isolated closed olecranon fractures in elderly patients.
Using a United States Medicare claims database, the authors identified 570 operative and 1,863 nonoperative olecranon fractures between 2005 and 2014. The authors retrospectively determined cost of treatment from the payer perspective for a 1-year period after initial injury, including any surgical procedure, emergency room care, follow-up care, physical therapy, and management of complications.
One year after diagnosis, mean costs per patient were higher for operative treatment (United States dollars [US$]10,694 vs US$2,544). 31.05% of operative cases were associated with a significant complication compared with 4.35% of nonoperative cases. When excluding complications, mean costs per patient were still higher for operative treatment ($7,068 vs $2,320).
These findings show that nonoperative management for olecranon fractures in the elderly population leads to fewer complications and is less costly. Nonoperative management may be a higher-value management option for this patient population. These results will help inform management of olecranon fractures as payers shift toward value-based reimbursement models in which quality of care and cost influence surgical decision making.
Level IV.
老年尺骨鹰嘴骨折的手术治疗可能导致更多并发症，而疗效与非手术治疗相似。本研究的目的是分析老年患者单纯闭合性尺骨鹰嘴骨折手术治疗与非手术治疗的成本差异。
利用美国医疗保险索赔数据库，作者在2005年至2014年间确定了570例手术治疗的尺骨鹰嘴骨折和1863例非手术治疗的尺骨鹰嘴骨折。作者从支付方的角度回顾性地确定了初始损伤后1年的治疗成本，包括任何外科手术、急诊室护理、随访护理、物理治疗和并发症管理。
诊断后1年，手术治疗的患者平均成本更高（10,694美元对2,544美元）。31.05%的手术病例伴有严重并发症，而非手术病例为4.35%。排除并发症后，手术治疗的患者平均成本仍然更高（7,068美元对2,320美元）。
这些研究结果表明，老年人群尺骨鹰嘴骨折的非手术治疗并发症更少，成本更低。非手术治疗可能是该患者群体更具价值的治疗选择。随着支付方转向基于价值的报销模式，即医疗质量和成本影响手术决策，这些结果将有助于指导尺骨鹰嘴骨折的治疗。
四级。
