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European Journal of Orthopaedic Surgery & Traumatology

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Open Access 01-12-2020 | Care | Original Article

A health economic analysis of the management of open lower limb fractures in the elderly

Authors: Caitlin Pley, Katie Purohit, Matija Krkovic, Ali Abdulkarim

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 8/2020

Abstract

Aim

The aim of this study was to investigate the financial implications of the inpatient management of open lower limb fractures in adults over 65 years old. Further, the study compares the calculated cost to the income received by the hospital for these patients and to the existing body of literature.

Methods

This study employed direct inpatient costing analysis to estimate the cost of treating the open lower limb fractures incurred by 58 patients over the age of 65 years treated in our centre (Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust) between March 2014 and March 2019.

Results

The median cost of inpatient care calculated in this study was £20,398 per patient, resulting in a financial loss to the hospital of £5113 per patient. When the results were disaggregated by sex, the median cost for an open lower limb fracture in a male patient was £20,886 compared to £19,304 in a female patient. Data were also disaggregated by the site of injury, which produced a median cost for an open femur fracture of £23,949, and £24,549 and £15,362 for open tibia and ankle fractures, respectively.

Conclusion

This study provides a valuable estimate of the expense of treating open lower limb fractures in patients over the age of 65 years in a Major Trauma Centre in England. The study highlights the large losses incurred by hospitals in treating these cases, and supports revision of the remuneration structures in the National Health Service to adequately cover their cost.

Appleby J (2013) Spending in health and social care over the next 50 years: Why think long term? (Internet), London (cited 2019 Nov 17). Available from: www.kingsfund.org.uk

Healthcare expenditure, UK health accounts - Office for National Statistics (Internet), (cited 2019 Nov 17). Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/ukhealthaccounts/2017

How does UK healthcare spending compare with other countries? - Office for National Statistics (Internet), (cited 2019 Nov 17). Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29

The NHS budget and how it has changed | The King’s Fund (Internet), (cited 2019 Nov 17). Available from: https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget

2019/20 National tariff payment system (2019) A joint publication by NHS England and NHS improvement

Overview | Fractures (complex): assessment and management | Guidance | NICE (2016) (cited 2019 Nov 17). Available from: https://www.nice.org.uk/guidance/ng37

British Orthopaedic Association and British Association of Plastic, Reconstructive and Aesthetic Surgeons Standard for Trauma-2009 BOAST 4 (2009) The management of severe open lower limb fractures (Internet), (cited 2019 Nov 17). Available from: www.boa.ac.uk

Tissingh EK, Memarzadeh A, Queally J, Hull P (2017) Open lower limb fractures in Major Trauma Centers—A loss leader? Injury (Internet), (cited 2019 Mar 18); 48(2):353–356. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28087118

Townley WA, Urbanska C, Dunn RLR, Khan U (2011) Costs and coding—free-flap reconstruction in lower-limb trauma. Injury 42(4):381–384CrossRef

10.

Govender S, Csimma C, Genant HK, Valentin-Opran A, Amit Y, Arbel R et al (2002) Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Jt Surg Ser A 84(12):2123–2134CrossRef

11.

Alt V, Donell ST, Chhabra A, Bentley A, Eicher A, Schnettler R (2009) A health economic analysis of the use of rhBMP-2 in Gustilo-Anderson grade III open tibial fractures for the UK, Germany, and France. Injury 40(12):1269–1275CrossRef

12.

Haddad FS, McLawhorn AS (2016) Guidelines for reporting health economic research. Bone Jt J Br Editor Soc Bone Jt Surg 98B:147–151CrossRef

13.

Leal J, Manetti S, Buchanan J (2018) The impact of hospital costing methods on cost-effectiveness analysis: a case study. Pharmacoeconomics (Internet), (cited 2019 Dec 23); 36(10):1263–1272. Available from: https://link.springer.com/10.1007/s40273-018-0673-y

14.

Scottish Health Service Costs Publication Report (2011) (Internet), (cited 2019 Nov 14). Available from: https://www.isdscotland.org/Health-Topics/Finance/Publications/2011-11-29/2011-11-29-Costs-Report.pdf

15.

Costa ML, Achten J, Parsons NR, Rangan A, Griffin D, Tubeuf S et al (2014) Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial. BMJ 5:349

16.

Griffiths EJ, Stevenson D, Porteous MJ (2012) Cost savings of using a cemented total hip replacement: An analysis of the national joint registry data. J Bone Jt Surg Ser B 94B(8):1032–1035CrossRef

17.

Mayer E, Faiz O, Athanasiou T, Vincent C (2008) Measuring and enhancing elective service performance in NHS operating theatres: an overview. J R Soc Med (Internet), (cited 2019 Nov 14); 101(6):273–277. Available from: https://journals.sagepub.com/doi/10.1258/jrsm.2008.080130

18.

Open Fractures - British Orthopaedic Association & British Association of Plastic, Reconstructive & Aesthetic Surgeons Audit Standards for Trauma (2017) (Internet), (cited 2020 May 8). Available from: https://www.boa.ac.uk/uploads/assets/3b91ad0a-9081-4253-92f7d90e8df0fb2c/29bf80f1-1cb6-46b7-afc761119341447f/openfractures.pdf

19.

Unit Costs of Health and Social Care (2017) (Internet), (cited 2019 Nov 14). Available from: https://www.nhsemployers.org/your-workforce/pay-and-reward/pay/job-evaluation/national-job-profiles

20.

Beck B, Cameron P, Lowthian J, Fitzgerald M, Judson R, Gabbe BJ (2018) Major trauma in older persons. BJS Open (Internet), (cited 2019 Dec 21); 2(5):310–318. Available from: https://doi.wiley.com/10.1002/bjs5.80

21.

NHS Salaries in the United Kingdom | Indeed.co.uk (Internet), (cited 2019 Nov 25). Available from: https://www.indeed.co.uk/cmp/Nhs/salaries

22.

Tucker D, Parry M, Packham I (2016) Financial ramifications of inaccurate clinical coding in two common orthopaedic procedures. Bull R Coll Surg Engl 98(1):34–37CrossRef

23.

Trusts in deficit | The King’s Fund (Internet), (cited 2019 Dec 21). Available from: https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/trusts-deficit

24.

Kehoe A, Smith JE, Edwards A, Yates D, Lecky F (2015) The changing face of major trauma in the UK. Emerg Med J 32(12):911–915CrossRef

25.

WHO (2004) What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? (Internet), (cited 2019 Dec 22). Available from: https://www.euro.who.int/document/E82552.pdf

26.

Court-Brown CM, Biant LC, Clement ND, Bugler KE, Duckworth AD, McQueen MM (2015) Open fractures in the elderly. The importance of skin ageing. Injury 46(2):189–194CrossRef

27.

Noblet TM, Jackson PC, Foster P, Taylor DM, Harwood PJ, Wiper JD (2018) Managing soft tissues in severe lower limb trauma in an ageing population. Injury 49(6):1197–1202CrossRef

28.

TARN (The Trauma Audit & Research Network) (2017) Major trauma in older people (Internet). England & Wales, (cited 2019 Dec 21). Available from: https://www.tarn.ac.uk/content/downloads/3793/MajorTrauma in Older People 2017.pdf%0D

29.

Raven D, Hall R, Roberts S, Littleson S, Graham S. Midlands silver trauma group. The silver safety Net—A proposal for a regional trauma desk response to triage older people with injuries (Internet), (cited 2019 Dec 22). Available from: https://nebula.wsimg.com/6384c4de4bf0a46336ba47daf90967a8?AccessKeyId=71C7B1EA5618F4C499E1&disposition=0&alloworigin=1

30.

Inflation calculator (Internet), Bank of England, (cited 2020 May 12). Available from: https://www.bankofengland.co.uk/monetary-policy/inflation/inflation-calculator

Title: A health economic analysis of the management of open lower limb fractures in the elderly
Authors: Caitlin Pley
Katie Purohit
Matija Krkovic
Ali Abdulkarim
Publication date: 01-12-2020
Publisher: Springer Paris
Keyword: Care
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 8/2020
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-020-02713-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A health economic analysis of the management of open lower limb fractures in the elderly

Abstract

Aim

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Methods

Results

Conclusion

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