Sat., 10/15/11 Recon, UE, Wrist & Hand, Paper #86, 3:59 pm OTA-2011
Clinical and Financial Comparison of Operative and Nonoperative Treatment of Displaced Clavicle Fractures
Peter L. Althausen, MD, MBA1; Steven Shannon, BS2;
Timothy J. O’Mara, MD1; Timothy J. Bray, MD1;
1Reno Orthopaedic Clinic, Reno, Nevada, USA;
2University of Nevada School of Medicine, Reno, Nevada, USA
Purpose: Surgical stabilization of displaced clavicle fractures was once considered to have rare indications. Over the past few years, several studies have demonstrated the clinical effectiveness of this procedure. A recent study presented a cost-effectiveness analysis of open reduction and internal fixation after acute fracture utilizing event probabilities and decision-tree analysis. However, no study to date has collected actual financial data from the patients themselves.
Methods: From January 2005 to January 2010, our fracture database was queried to identify patients treated for clavicular fractures. Radiographs were reviewed by a blinded author and total displacement was calculated by the sum of displacement on AP and cephalic tilt radiographs of the involved shoulder. 220 patients with displaced fractures were identified and financial questionnaires were mailed to patients.
Results: 182 responses were received, with 97 surgical and 85 nonsurgical responses. In our study, surgical patients had less chronic pain (4.0% vs 18.9%), less cosmetic deformity (13% vs 35.8%), less weakness(4.4% vs 43.4%), less loss of motion (4.4% vs 35.8%), and fewer nonunions (0 vs 1.9%). Operative patients were more likely to be satisfied with their outcome (96% vs 79%). Surgical patients missed an average of 9.2 days of work while nonoperatively managed patients missed a mean of 36.9 days. They also required less family assistance (2.6 days vs 7 days) for care at home. Mean income lost due to injury was $275 vs $13,092. Operative care had a mean emergency room bill of $1,924 versus $2,336, a mean hospital bill of $9,196 versus $4,103, and anesthesia charges averaged $949. Operative patients required fewer physical therapy visits and mean physical therapy cost was $770 versus $1,920. Nonoperative patients required slightly more pain medication ($45 vs $55). Overall, cost differential was $13,265 for patients treated with surgical stabilization and $27,636 for nonoperatively managed patients.
Conclusions: Patients with displaced clavicle fractures benefit clinically and financially from surgical stabilization. Clinically they have less chronic pain, less deformity, less weakness, and better range of motion. They return to work sooner, take less pain medication, and require less physical therapy. Their initial hospital bill is higher due to surgical charges but this is balanced by less income loss, resulting in a cost difference of $14,371 in operatively managed patients.
Alphabetical Disclosure Listing (628K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.