MedTech Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA.
DePuy Synthes, West Chester, PA, USA.
J Orthop Surg Res. 2023 Oct 3;18(1):745. doi: 10.1186/s13018-023-04232-3.
Few contemporary US-based long bone non-union analyses have recently been published. Our study was designed to provide a current understanding of non-union risks and costs, from the payers' perspective.
The Merative™ MarketScan Commercial Claims and Encounters database was used. Patients with surgically treated long bone (femur, tibia, or humerus) fractures in the inpatient setting, from Q4 2015 to most recent, were identified. Exclusion criteria included polytrauma and amputation at index. The primary outcome was a diagnosis of non-union in the 12 and 24 months post-index. Additional outcomes included concurrent infection, reoperation, and total healthcare costs. Age, gender, comorbidities, fracture characteristics, and severity were identified for all patients. Descriptive analyses were performed. Crude and adjusted rates of non-union (using Poisson regressions with log link) were calculated. Marginal incremental cost of care associated with non-union and infected non-union and reoperation were estimated using a generalized linear model with log link and gamma distribution.
A total of 12,770, 13,504, and 4,805 patients with femoral, tibial, or humeral surgically treated fractures were identified, 74-89% were displaced, and 18-27% were comminuted. Two-year rates of non-union reached 8.5% (8.0%-9.1%), 9.1% (8.6%-9.7%), and 7.2% (6.4%-8.1%) in the femoral, tibial, and humeral fracture cohorts, respectively. Shaft fractures were at increased risk of non-union versus fractures in other sites (risk ratio (RR) in shaft fractures of the femur: 2.36 (1.81-3.04); tibia: 1.95 (1.47-2.57); humerus: 2.02 (1.42-2.87)). Fractures with severe soft tissue trauma (open vs. closed, Gustilo III vs. Gustilo I-II) were also at increased risk for non-union (RR for Gustilo III fracture (vs. closed) for femur: R = 1.96 (1.45-2.58), for tibia: 3.33 (2.85-3.87), RR for open (vs. closed) for humerus: 1.74 (1.30-2.32)). For all fractures, younger patients had a reduced risk of non-union compared to older patients. For tibial fractures, increasing comorbidity (Elixhauser Index 5 or greater) was associated with an increased risk of non-union. The two-year marginal cost of non-union ranged from $33K-$45K. Non-union reoperation added $16K-$34K in incremental costs. Concurrent infection further increased costs by $46K-$86K.
Non-union affects 7-10% of surgically treated long bone fracture cases. Shaft and complex fractures were at increased risk for non-union.
最近很少有基于美国的长骨不愈合的分析报告。我们的研究旨在从支付者的角度了解非愈合的风险和成本。
使用 Merative ™ MarketScan 商业索赔和遭遇数据库。从 2015 年第四季度到最近，确定了在住院环境中接受手术治疗的长骨（股骨、胫骨或肱骨）骨折患者。排除标准包括多发伤和指数截肢。主要结果是在指数后 12 个月和 24 个月诊断为非愈合。其他结果包括同时发生的感染、再次手术和总医疗费用。对所有患者识别年龄、性别、合并症、骨折特征和严重程度。进行描述性分析。使用泊松回归（对数链接）计算非愈合（未愈合）的粗率和调整率。使用对数链接和伽马分布的广义线性模型估计与非愈合和感染性非愈合以及再次手术相关的边际增量护理成本。
总共确定了 12770 例、13504 例和 4805 例接受股骨、胫骨或肱骨手术治疗的骨折患者，74%-89%为移位骨折，18%-27%为粉碎性骨折。股骨、胫骨和肱骨骨折队列中，2 年非愈合率分别达到 8.5%（8.0%-9.1%）、9.1%（8.6%-9.7%）和 7.2%（6.4%-8.1%）。与其他部位骨折相比，骨干骨折的非愈合风险更高（股骨骨干骨折的风险比（RR）为 2.36（1.81-3.04）；胫骨骨干骨折为 1.95（1.47-2.57）；肱骨骨干骨折为 2.02（1.42-2.87））。严重软组织创伤（开放性 vs. 闭合性，Gustilo III 型 vs. Gustilo I-II 型）的骨折也有更高的非愈合风险（Gustilo III 型骨折（vs. 闭合性）的 RR 为股骨：RR=1.96（1.45-2.58），胫骨：RR=3.33（2.85-3.87），开放性（vs. 闭合性）的 RR 为肱骨：RR=1.74（1.30-2.32））。对于所有骨折，与老年患者相比，年轻患者非愈合的风险降低。对于胫骨骨折，合并症增加（Elixhauser 指数 5 或更高）与非愈合风险增加相关。非愈合的两年边际成本在 33000 美元至 45000 美元之间。非愈合再手术增加了 16000 美元至 34000 美元的增量成本。同时发生感染会进一步增加 46000 美元至 86000 美元的成本。
非愈合影响 7%-10%的手术治疗长骨骨折病例。骨干和复杂骨折的非愈合风险更高。
