Predictors of Episode-of-Care Costs for Ankle Fractures.

Ankle fractures are one of the most resource-consuming traumatic orthopedic injuries. Few studies have successfully evaluated the episode-of-care costs (EOCC) of common traumatic orthopedic injuries. The objective of this study was to determine the EOCC associated with the surgical management of ankle fractures. A retrospective cohort study of 105 consecutive patients who underwent open reduction internal fixation of an isolated ankle fracture at a Canadian Level-1 trauma center was conducted. Episode-of-care costs were generated using an activity-based costing framework. The median global episode-of-care cost for ankle fracture surgeries performed at the studied institution was $3,487 CAD [IQR 880] ($2,685 USD [IQR 616]). Patients aged 60 to 90 years had a significantly higher median EOCC than younger patients (p = .01). Supination-adduction injuries had a significantly higher median EOCC than other injury patterns (p = .01). The median EOCC for patients who underwent surgery within 10 days of their injury ($3,347 CAD [582], $2,577 USD [448]) was significantly lower than the cost for patients who had their surgery delayed 10 days or more after the injury ($3,634 CAD [776], $2,798 USD [598]) (p = .03). Patient sex, anesthesia type, ASA score and surgeon's fellowship training did not affect the EOCC. This study provides valuable data on predictors of EOCC in the surgical management of ankle fractures. Delaying simple ankle fracture cases due to operating time constraints can increase the total cost and burden of these fractures on the healthcare system. In addition, this study provides a framework for future episode-of-care cost analysis studies in orthopedic surgery.

Hospital episode-of-care costs for hip fractures: an activity-based costing analysis.

Background: Despite the large impact of hip fracture care on hospital budgets, accurate episode-of-care costs (EOCC) calculations for this injury remains a challenge. The objective of this article was to assess EOCC for geriatric patients with hip fractures using an activity-based costing methodology and identify intraoperative, perioperative, and patient-specific factors associated with higher EOCC. Material and Methods: This is a retrospective cohort study involving a total of 109 consecutive patients with hip fracture treated surgically at a Canadian level-1 trauma center from April 2018 to February 2019. Clinical and demographic data were extracted through the institution's centralized data warehouse. Data acquisition also included direct and indirect costs per episode of care, adverse events, and precise temporal data. Results: The median total EOCC was $13,113 (interquartile range 6658), excluding physician fees. Out of the total cost, 75% was attributed to direct costs, which represented a median expenditure of $9941. The median indirect cost of the EOCC was $3322. Based on the multivariate analysis, patients not operated within the 48 hours guidelines had an increased length of stay by 5.7 days (P = 0.003), representing an increase in EOCC of close to 5000$. Higher American Society of Anesthesiology (ASA) scores were associated with elevated EOCC. Conclusion: The cost of managing a patient with geriatric hip fracture from arrival in the emergency department to discharge from surgical ward represented $13,113. Main factors influencing the EOCC included adherence to the 48-hour benchmark surgical delay and ASA score. High-quality costing data are vital in assessing health care spending, conducting cost effectiveness analyses, and ultimately in guiding policy decisions. Level of Evidence: Level III (3), retrospective cohort study.

Episode-of-care costs of total hip arthroplasty: day surgery versus same-day admission.

BACKGROUND: Although day surgery (DS) total hip arthroplasty (THA) has good patient satisfaction and a good safety profile, accurate episode-of-care cost (EOCC) calculations for this procedure compared to standard same-day admission (SDA) THA are not well known. We determined the EOCCs for patients who underwent THA, comparing DS and SDA pathways. METHODS: We evaluated the EOCCs for consecutive patients who underwent DS or SDA THA for osteoarthritis or osteonecrosis performed by a single surgeon at 1 academic centre from July 2018 to January 2020. Patient demographic and clinical data were recorded, as were preoperative diagnosis, type of anesthesia, type of implant used, surgical time and estimated blood loss. We determined direct and indirect costs from time of arrival at the presurgical unit to hospital discharge. We determined the EOCCs using an ABC method. RESULTS: The study included 50 patients who underwent THA (25 DS, 25 SDA). The mean length of stay in the SDA group was 45.1 (standard deviation [SD] 21.4) hours. Differences were observed between the 2 groups in mean age, mean Charlson Comorbidity Index score, surgical technique and mean surgical time (p ≤ 0.001). The mean total EOCC for SDA THA was $10 911 (SD $706.12, range $9944.07-$12 871.95), compared to $9672 (SD $546.55, range $8838.30-$11 058.07) for DS THA, a difference of 11.4%, mostly attributable to hospital resources such as laboratory tests, radiologic studies and cost of the surgical admission. CONCLUSION: Day surgery THA is cost-effective in selected patient populations. With the savings identified in this study, every 10 additional DS THA procedures would save sufficient resources to perform an additional THA operation.