| アブストラクト | OBJECTIVES: Determine the impact of infections on direct costs and healthcare resource use in England for patients undergoing intramedullary nailing (IMN) for tibial shaft fractures. DESIGN: Non-concurrent cohort based on retrospectively collected data with 2-year follow-up. SETTING: England. PARTICIPANTS: The study population included adult patients (>/=18 years) in England with a diagnosis of tibial shaft fracture (International Classification of Diseases-10, S822) in the inpatient setting between May 2003 and June 2017 followed by a procedure for IMN for tibial shaft fracture within 30 days. Patient data were derived from the Clinical Practice Research Datalink linked to National Health Service Hospital Episode Statistics datasets. PRIMARY INDEPENDENT VARIABLE: Infection. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was total inpatient costs from index stay admission through 1 year of follow-up. Secondary outcome included cumulative total healthcare costs, and resource utilisation at 30 days, 90 days, 1 year and 2 years. RESULTS: Overall, 805 patients met the inclusion criteria. At index inpatient stay, 3.7% had a post-IMN infection, rising to 11.7% at 1 year. One-year inpatient costs were 80% higher for patients with infection (p<0.001). Total costs were estimated to be pound14 756 (95% CI pound13 123 to pound16 593) for patients with infection versus pound8279 (95% CI pound7946 to pound8626). Length of stay (LOS), readmission and reoperation were the key drivers of healthcare costs (all p<0.001). After adjustment, LOS was higher by 109% (95% CI 62% to 169%), from 10.5 days to 21.9 days, for patients with infection. The odds of being readmitted or requiring reoperation were higher by 5.18 times (95% CI 3.01 to 9.13) and 2.47 times (95% CI 1.48 to 4.09), respectively, for patients with infection versus those without infection. CONCLUSIONS: Post-IMN infection significantly increases inpatient costs, LOS, readmissions and reoperations associated with tibial fracture fixation. Healthcare burden could be reduced through novel surgical site infection prevention strategies. |
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| ジャーナル名 | BMJ open |
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| 投稿日 | 2020/8/28 |
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| 投稿者 | Galvain, Thibaut; Chitnis, Abhishek; Paparouni, Konstantina; Tong, Cindy; Holy, Chantal E; Giannoudis, Peter V |
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| 組織名 | Department of Health Economics and Market Access, Johnson and Johnson Medical;Devices, Issy-les-Moulineaux, France tgalvain@its.jnj.com.;Department of Real World Analytics and Research, Johnson and Johnson Medical;Devices, New Brunswick, New Jersey, USA.;Department of Health Economics and Market Access, DePuy Synthes, Zuchwil,;Switzerland.;Devices, Somerville, New Jersey, USA.;Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS;Trust, Leeds, West Yorkshire, UK.;School of Medicine, University of Leeds, Leeds, West Yorkshire, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/32847903/ |
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