目的:评估荷兰学术环境中与开放性下肢骨折治疗相关的一年直接费用。次要目标是评估深部感染和骨不愈合对一年总直接成本的影响。
方法:多中心,在荷兰的学术环境中治疗的开放性下肢骨折的回顾性成本分析,在2017年1月1日至2018年12月31日期间进行。成本计算方法基于使用自下而上方法的患者水平汇总。使用多元线性回归模型来预测基于骨折相关感染的总成本,多发性创伤,重症监护病房(ICU)入院,Gustilo-Anderson等级和骨不连。
结果:总体而言,包括70个骨折进行分析,大多数Gustilo-AndersonIII级骨折(57%)。一年的住院费用中位数(IQR)为31,258欧元(20,812-58,217)。费用主要归因于住院时间(58%)和外科手术(30%)。平均住院时间为16天,骨折相关感染增加到50天。后续成本(46,075[25,891-74,938]与15,244[8970-30,173];p=0.002),和医院总费用(90,862[52,868-125,004]与29,297[21,784-40,677];p<0.001)对于感染病例明显更高。发现骨折相关感染,多发性创伤,Gustilo-AndersonIIIA-C级骨折是成本增加的重要预测因素。
结论:在开放性下肢骨折的治疗中,深部感染,更高的Gustilo-Anderson分类,和多发性创伤显著增加了医院的直接成本。考虑到感染对发病率和总医疗费用的影响,未来的研究应该集中在预防骨折相关感染上.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.