Nyffeler Ramon, Morgenstern Mario, Osinga Rik, Kuehl Richard, Gahl Brigitta, Imhof Anna, Meyer Carl-Philipp, Müller Seraina, Muri Thadeus, Schaefer Dirk Johannes, Sendi Parham, Clauss Martin
Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland.
Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland; Department of Orthopedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.
Injury. 2025 Feb;56(2):112138. doi: 10.1016/j.injury.2024.112138. Epub 2024 Dec 28.
Fracture-related infection (FRI) is a feared complication in orthopaedic trauma surgery. They are associated with multiple surgical interventions and prolonged antibiotic treatment duration, and hence, increased costs. The objective of this study was to assess the costs of FRI treatment in a Tertiary Swiss Trauma Center and to identify the variables associated with increased costs.
In this retrospective cohort study, 116 patients with an FRI treated in a Swiss tertiary center between 01/2012 and 12/2019 were included. Clinical data and the costs of each hospital stay were evaluated. Predefined variables were categorized as modifiable and non-modifiable factors and examined for their influence on costs and hospital length of stay (LOS) in univariable and multivariable analyses.
The median cost per patient was 39,219 [interquartile range (IQR) 22,657 to 68,588] CHF. The median LOS was 21 [IQR 14 to 36] days. Most patients were male (67%) with a median age of 58 years [40-70]. The median duration of IV antibiotic use was 16 [9-27] days. Costs related to hospitalization (nursing and physiotherapy) accounted for the highest expenses with a relative share of 49%, whereas surgical procedures had a minor impact on the total cost with a relative share of 19%. In the univariable analysis, significant drivers of both costs and LOS were the number of FRI surgeries, the use of negative pressure wound therapy, duration of IV antibiotic treatment, and cases with a change of surgical strategy. After adjustment for patient and treatment factors, duration of IV antibiotics and change of surgical strategy were associated with higher costs.
This study illustrates the financial burden of FRI in a DRG system and identifies potential drivers for these costs. Since repeated surgeries or unplanned surgical revisions are drivers of costs, optimal pre-operative planning and coordination between the involved disciplines is key to minimize costs. Management in multidisciplinary teams that are specialized in the treatment of these complex and cost-intensive patients may therefore reduce the financial burden.
骨折相关感染（FRI）是骨科创伤手术中令人担忧的并发症。它们与多次手术干预和延长的抗生素治疗时间相关，因此成本增加。本研究的目的是评估瑞士一家三级创伤中心FRI治疗的成本，并确定与成本增加相关的变量。
在这项回顾性队列研究中，纳入了2012年1月至2019年12月期间在瑞士一家三级中心接受治疗的116例FRI患者。评估了临床数据和每次住院的费用。将预定义变量分类为可改变和不可改变因素，并在单变量和多变量分析中检查它们对成本和住院时间（LOS）的影响。
每位患者的中位成本为39,219瑞士法郎[四分位间距（IQR）22,657至68,588]。中位住院时间为21天[IQR 14至36天]。大多数患者为男性（67%），中位年龄为58岁[40 - 70岁]。静脉使用抗生素的中位时间为16天[9 - 27天]。与住院相关的成本（护理和物理治疗）占最高费用，相对份额为49%，而手术程序对总成本的影响较小，相对份额为19%。在单变量分析中，成本和住院时间的显著驱动因素是FRI手术的次数、负压伤口治疗的使用、静脉抗生素治疗的持续时间以及手术策略改变的病例。在对患者和治疗因素进行调整后，静脉抗生素的持续时间和手术策略的改变与更高的成本相关。
本研究说明了DRG系统中FRI的经济负担，并确定了这些成本的潜在驱动因素。由于重复手术或计划外的手术翻修是成本的驱动因素，因此最佳的术前规划和相关学科之间的协调是将成本降至最低的关键。因此，由专门治疗这些复杂且成本高昂患者的多学科团队进行管理可能会减轻经济负担。
