Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Eur J Trauma Emerg Surg. 2024 Oct;50(5):2605-2613. doi: 10.1007/s00068-024-02637-1. Epub 2024 Aug 26.
To estimate the one-year sum of direct costs related to open lower limb fracture treatment in an academic setting in the Netherlands. The secondary objective was to estimate the impact of deep infection and nonunion on one-year total direct costs.
A multi-center, retrospective cost analysis of open lower limb fractures treated in an academic setting in the Netherlands, between 1 January 2017 and 31 December 2018, was conducted. The costing methodology was based on patient level aggregation using a bottom-up approach. A multiple linear regression model was used to predict the total costs based on Fracture-related-infections, multitrauma, intensive care unit (ICU) admission, Gustilo-Anderson grade and nonunion.
Overall, 70 fractures were included for analysis, the majority Gustilo-Anderson grade III fractures (57%). Median (IQR) one-year hospital costs were €31,258 (20,812-58,217). Costs were primarily attributed to the length of hospital stay (58%) and surgical procedures (30%). The median length of stay was 16 days, with an increase to 50 days in Fracture-related infections. Subsequent costs (46,075 [25,891-74,938] vs. 15,244 [8970-30,173]; p = 0.002), and total hospital costs (90,862 [52,868-125,004] vs. 29,297 [21,784-40,677]; p < 0.001) were significantly higher for infected cases. It was found that Fracture-related infection, multitrauma, and Gustilo-Anderson grade IIIA-C fractures were significant predictors of increased costs.
In treatment of open lower limb fractures, deep infection, higher Gustilo-Anderson classification, and multitrauma significantly increase direct hospital costs. Considering the impact of infection on morbidity and total healthcare costs, future research should focus on preventing Fracture-related infections.
估算在荷兰学术环境下治疗开放性下肢骨折的一年直接成本总额。次要目标是评估深部感染和非愈合对一年总直接成本的影响。
对 2017 年 1 月 1 日至 2018 年 12 月 31 日在荷兰学术环境下治疗的开放性下肢骨折患者进行了一项多中心、回顾性成本分析。成本核算方法基于使用自下而上方法进行患者水平汇总。使用多元线性回归模型根据骨折相关感染、多发创伤、重症监护病房（ICU）入院、Gustilo-Anderson 分级和非愈合情况预测总成本。
共有 70 例骨折纳入分析，其中大多数为 Gustilo-Anderson 分级 III 型骨折（57%）。一年期医院总费用中位数（IQR）为 31258 欧元（20812-58217）。费用主要归因于住院时间（58%）和手术程序（30%）。中位住院时间为 16 天，骨折相关感染增加至 50 天。后续费用（46075 [25891-74938] 欧元 vs. 15244 [8970-30173] 欧元；p = 0.002）和总住院费用（90862 [52868-125004] 欧元 vs. 29297 [21784-40677] 欧元；p < 0.001）在感染病例中显著更高。结果发现，骨折相关感染、多发创伤和 Gustilo-Anderson 分级 IIIA-C 骨折是增加费用的显著预测因素。
在开放性下肢骨折治疗中，深部感染、较高的 Gustilo-Anderson 分级和多发创伤显著增加直接住院费用。考虑到感染对发病率和总医疗保健成本的影响，未来的研究应侧重于预防骨折相关感染。
