Cost consequence analysis of waiting for lumbar disc herniation surgery.

The economic repercussions of waiting for lumbar disc surgery have not been well studied. The primary goal of this study was to perform a cost-consequence analysis of patients receiving early vs late surgery for symptomatic disc herniation from a societal perspective. Secondarily, we compared patient factors and patient-reported outcomes. This is a retrospective analysis of prospectively collected data from the CSORN registry. A cost-consequence analysis was performed where direct and indirect costs were compared, and different outcomes were listed separately. Comparisons were made on an observational cohort of patients receiving surgery less than 60 days after consent (short wait) or 60 days or more after consent (long wait). This study included 493 patients with surgery between January 2015 and October 2021 with 272 patients (55.2%) in the short wait group and 221 patients (44.8%) classified as long wait. There was no difference in proportions of patients who returned to work at 3 and 12-months. Time from surgery to return to work was similar between both groups (34.0 vs 34.9 days, p = 0.804). Time from consent to return to work was longer in the longer wait group corresponding to an additional $11,753.10 mean indirect cost per patient. The short wait group showed increased healthcare usage at 3 months with more emergency department visits (52.6% vs 25.0%, p < 0.032), more physiotherapy (84.6% vs 72.0%, p < 0.001) and more MRI (65.2% vs 41.4%, p < 0.043). This corresponded to an additional direct cost of $518.21 per patient. Secondarily, the short wait group had higher baseline NRS leg, ODI, and lower EQ5D and PCS. The long wait group had more patients with symptoms over 2 years duration (57.6% vs 34.1%, p < 0.001). A higher proportion of patients reached MCID in terms of NRS leg pain at 3-month follow up in the short wait group (84.0% vs 75.9%, p < 0.040). This cost-consequence analysis of an observational cohort showed decreased costs associated with early surgery of $11,234.89 per patient when compared to late surgery for lumbar disc herniation. The early surgery group had more severe symptoms with higher healthcare utilization. This is counterbalanced by the additional productivity loss in the long wait group, which likely have a more chronic disease. From a societal economic perspective, early surgery seems beneficial and should be promoted.

Mortality Rate of Geriatric Acetabular Fractures Is High Compared With Hip Fractures. A Matched Cohort Study.

OBJECTIVES: Compare acute complication and mortality rates of geriatric patients with acetabular fractures (AFs) matched to hip fractures (HFs). DESIGN: Retrospective cohort study. SETTING: American College of Surgeons National Surgical Quality Improvement Project. PATIENTS: Using Current Procedural Terminology codes, the American College of Surgeons National Surgical Quality Improvement Project registry was used to identify all patients ≥60 years from 2011 to 2016 treated for AFs undergoing open reduction internal fixation (ORIF) and HFs (undergoing ORIF, hemiarthroplasty, or cephalomedullary nail). OUTCOME MEASUREMENTS: Patient characteristics, comorbidities, functional status, acute complications, and mortality rates were recorded. Patients were matched 1:5 (AF:HF). Chi-square, Fisher exact, and Mann-Whitney U tests were used to compare groups, and multivariable logistic regression was used to compare the risk of complications or death while adjusting for relevant covariates. RESULTS: A total of 303 AF patients (age: 78.2 ± 9.2 years/59.7% females/27.1% wall, 28.4% one column and 45.2% 2 columns ORIF) were matched to 1511 HF patients (age: 78.3 ± 9.1 years/60.2% females/37.2% hemiarthroplasty, 16.3% ORIF and 47.4% cephalomedullary nail). Length of stay (8.4 ± 7.1 vs. 6.4 ± 5.9 days) and time to surgery [(TS) 2.3 ± 1.8 versus 1.2 ± 1.4 days] were longer in the AF group (P < 0.01). Unadjusted mortality rates were nonsignificantly higher for AFs versus HFs (6.6% vs. 4.6%, P = 0.14). After covariable adjustment, the risk of mortality was significantly higher for AFs versus HFs (odds ratio: 1.89, 95% confidence interval: 1.07-3.35). CONCLUSION: Geriatric AFs pose a significantly higher adjusted mortality risk when compared with HF patients. Strategies to mitigate risk factors in this population are warranted. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Distal femoral varus osteotomy combined with tibial plateau fresh osteochondral allograft for post-traumatic osteoarthritis of the knee.

PURPOSE: This study was conducted to examine the long-term survivorship and functional outcome of distal femoral varus osteotomy with fresh osteochondral allograft following failed lateral tibial plateau fracture surgery. We hypothesized that this procedure would be associated with a low rate of conversion to total knee arthroplasty (TKA) at medium to long-term follow-up. METHODS: A consecutive series of 27 of distal femoral varus osteotomy combined with fresh osteochondral allograft following (27 patients) conducted between January 1981 and January 2005 for failed lateral tibial plateau fracture was retrospectively reviewed. Outcome measures included the Knee Society Knee Score (KSKS) and Knee Society Function Score (KSFS) and conversion rates to TKA. RESULTS: The study group consisted of 15 females (55.6 %) and 12 males (44.4 %), with a median age of 41.2 years (range 17-62 years). The median follow-up was 13.3 years (range 2-31 years). The knee function scores improved significantly at 2 years post-surgery (p < 0.01) from a median of 54.6 points preoperatively to 83.8 points (KSKS) and median of 50.6 points to 71.1 points (KSFS) at 2 years post-distal femoral varus osteotomy with fresh osteochondral allograft following surgery. At most recent follow-up, 4/27 patients had required conversion to TKA, and one patient had fractured the FOCA, requiring revision of the allograft. The survivorship for distal femoral varus osteotomy with fresh osteochondral allograft following was 88.9 ± 4.6 % at 10 years, 71.4 ± 18.1 % at 15 years, and 23.8 ± 11.1 % at 20 years. CONCLUSION: The use of distal femoral varus osteotomy combined with fresh osteochondral allograft following in patients with failed lateral tibial plateau fracture results in the majority of patients having good or excellent clinical outcomes and significantly delays the need for TKA in most patients. LEVEL OF EVIDENCE: Case series, Level IV.