PDF(Pubmed)
Abstract：
The refracture rate after major trauma is approximately half (57%) the refracture rate after a minimal trauma injury. Extending Fracture Liaison Service activity to include major trauma patients creates significant additional direct cost, but remains essentially cost neutral if notional savings through refracture risk reduction are taken into account.
OBJECTIVE: To compare the 3-year refracture rate following minimal trauma (MT) and non-minimal trauma (non-MT) injuries and evaluate the cost of extending fracture liaison service (FLS) operations to non-MT presentations.
METHODS: Patients aged 50, or above presenting to the John Hunter Hospital with a fracture in calendar year 2018 were identified through the Integrated Patient Management System (IPMS) of the Hunter New England Health Service\'s (HNEHS), and re-presentation to any HNEHS facility over the following 3 years monitored. The refracture rate of MT and non-MT presentations was compared and analysed using Cox proportional hazards regression models. The cost of including non-MT patients was estimated through the use of a previously conducted micro-costing analysis. The operational fidelity of the FLS to the previous estimate was confirmed by comparing the 3-year refracture rate of MT presentations in the two studies.
RESULTS: The 3-year refracture rate following a MT injury was 8% and after non-MT injury 4.5%. Extension of FLS activities to include non-MT patients in 2022 would have cost an additional $198,326 AUD with a notional loss/saving of $ - 26,625/ + 26,913 AUD through refracture risk reduction. No clinically available characteristic at presentation predictive of increased refracture risk was identified.
CONCLUSIONS: The 3-year refracture after a non-MT injury is about half (57%) that of the refracture rate after a MT injury. Extending FLS activity to non-MT patients incurs a significant additional direct cost but remains cost neutral if notional savings gained through reduction in refracture risk are taken into account.
OBJECTIVE: To compare the 3-year refracture rate following minimal trauma (MT) and non-minimal trauma (non-MT) injuries and evaluate the cost of extending fracture liaison service (FLS) operations to non-MT presentations.
METHODS: Patients aged 50, or above presenting to the John Hunter Hospital with a fracture in calendar year 2018 were identified through the Integrated Patient Management System (IPMS) of the Hunter New England Health Service\'s (HNEHS), and re-presentation to any HNEHS facility over the following 3 years monitored. The refracture rate of MT and non-MT presentations was compared and analysed using Cox proportional hazards regression models. The cost of including non-MT patients was estimated through the use of a previously conducted micro-costing analysis. The operational fidelity of the FLS to the previous estimate was confirmed by comparing the 3-year refracture rate of MT presentations in the two studies.
RESULTS: The 3-year refracture rate following a MT injury was 8% and after non-MT injury 4.5%. Extension of FLS activities to include non-MT patients in 2022 would have cost an additional $198,326 AUD with a notional loss/saving of $ - 26,625/ + 26,913 AUD through refracture risk reduction. No clinically available characteristic at presentation predictive of increased refracture risk was identified.
CONCLUSIONS: The 3-year refracture after a non-MT injury is about half (57%) that of the refracture rate after a MT injury. Extending FLS activity to non-MT patients incurs a significant additional direct cost but remains cost neutral if notional savings gained through reduction in refracture risk are taken into account.
摘要：
大创伤后的再骨折率大约是最小创伤后的再骨折率的一半（57％）。将骨折联络处的活动扩大到包括主要创伤患者，会产生大量额外的直接成本，但如果考虑到通过降低再骨折风险的名义节省，则基本上保持成本中立。
目的：比较小创伤（MT）和非小创伤（非MT）损伤后3年的再骨折率，并评估将骨折联络服务（FLS）手术扩展到非MT表现的费用。
方法：通过亨特新英格兰卫生服务（HNEHS）的综合患者管理系统（IPMS），确定了2018日历年到约翰·亨特医院就诊的50岁或以上骨折患者。并在接下来的3年内重新展示给任何HNEHS设施。使用Cox比例风险回归模型比较和分析了MT和非MT表现的再骨折率。通过使用先前进行的微观成本分析来估计包括非MT患者的成本。通过比较两项研究中MT表现的3年再骨折率，证实了FLS与先前估计的操作保真度。
结果：MT损伤后3年再骨折率为8%，非MT损伤后3年再骨折率为4.5%。2022年将FLS活动扩展到包括非MT患者将额外花费$198,326AUD，通过减少再骨折风险，名义损失/节省$-26,625/+26,913AUD。没有发现临床上可预测再骨折风险增加的特征。
结论：非MT损伤后3年再骨折约为MT损伤后再骨折率的一半（57%）。将FLS活动扩展到非MT患者会产生大量额外的直接成本，但如果考虑到通过降低再骨折风险而获得的名义节省，则保持成本中立。
目的：比较小创伤（MT）和非小创伤（非MT）损伤后3年的再骨折率，并评估将骨折联络服务（FLS）手术扩展到非MT表现的费用。
方法：通过亨特新英格兰卫生服务（HNEHS）的综合患者管理系统（IPMS），确定了2018日历年到约翰·亨特医院就诊的50岁或以上骨折患者。并在接下来的3年内重新展示给任何HNEHS设施。使用Cox比例风险回归模型比较和分析了MT和非MT表现的再骨折率。通过使用先前进行的微观成本分析来估计包括非MT患者的成本。通过比较两项研究中MT表现的3年再骨折率，证实了FLS与先前估计的操作保真度。
结果：MT损伤后3年再骨折率为8%，非MT损伤后3年再骨折率为4.5%。2022年将FLS活动扩展到包括非MT患者将额外花费$198,326AUD，通过减少再骨折风险，名义损失/节省$-26,625/+26,913AUD。没有发现临床上可预测再骨折风险增加的特征。
结论：非MT损伤后3年再骨折约为MT损伤后再骨折率的一半（57%）。将FLS活动扩展到非MT患者会产生大量额外的直接成本，但如果考虑到通过降低再骨折风险而获得的名义节省，则保持成本中立。
