Thoracolumbar spinal arthrodesis - epidemiology and costs / Artrodese de coluna toracolombar - epidemiologia e custos / Artrodesis de la columna toracolumbar - epidemiología y costos

ABSTRACT Objective: To describe the epidemiology of patients with thoracolumbar spine fracture submitted to surgery at Hospital Cristo Redentor and the related costs. Methods: Prospective epidemiological study between July 2014 and August 2015 of patients with thoracolumbar spine fracture with indication of surgery. The variables analyzed were sex, age, cost of hospitalization, fractured levels, levels of arthrodesis, surgical site infection, UTI or BCP, spinal cord injury, etiology, length of stay, procedure time, and visual analog scale (VAS) . Results: Thirty-two patients were evaluated in the study period, with a mean age of 38.68 years. Male-female ratio was 4:1 and the most frequent causes were fall from height (46.87%) and traffic accidents (46.87%). The thoracolumbar transition was the most affected (40.62%), with L1 vertebra involved in 23.8% of the time. Neurological deficit was present in 40.62% of patients. Hospital stay had a median of 14 days and patients with neurological deficit were hospitalized for a longer period (p<0.001), with an increase in hospital costs (p= 0.015). The average cost of hospitalization was U$2,874.80. The presence of BCP increased the cost of hospitalization, and patients with spinal cord injury had more BCP (p= 0.014) . Conclusion: Public policies with an emphasis on reducing traffic accidents and falls can help reduce the incidence of these injuries and studies focusing on hospital costs and rehabilitation need to be conducted in Brazil to determinate the burden of spinal trauma and spinal cord injury.

RESUMO Objetivo: Descrever a epidemiologia dos pacientes com fratura de coluna toracolombar submetidos à cirurgia no Hospital Cristo Redentor e os custos relacionados. Métodos: Estudo epidemiológico prospectivo entre julho de 2014 e agosto de 2015 de pacientes com fratura da coluna toracolombar com indicação de cirurgia. Foram analisadas as variáveis sexo, idade, custo da internação hospitalar, níveis fraturados, níveis de artrodese, infecção de sítio cirúrgico, ITU ou BCP, lesão medular, etiologia, dias de internação, tempo de procedimento e escala visual analógica (EVA) . Resultados: Foram avaliados 32 pacientes no período estudado, com média de idade de 38,68 anos. A relação entre homens e mulheres foi 4:1 e as causas mais frequentes foram queda de altura (46,87%) e acidentes de trânsito (46,87%). A transição toracolombar foi a mais acometida (40,62%) com a vértebra de L1 envolvida em 23,8% das vezes. Apresentaram déficit neurológico 40,62% dos pacientes. O tempo de permanência hospitalar teve mediana de 14 dias e os pacientes com déficit neurológico permaneceram internados por período mais prolongado (p <0,001), com aumento dos custos hospitalares (p= 0,015). O custo médio da internação foi de U$ 2.874,80. A presença de BCP aumentou o custo da internação e os pacientes com lesão medular tiveram mais BCP (p= 0,014). Conclusão: Políticas públicas com ênfase na redução de acidentes de trânsito e quedas podem ajudar a reduzir a incidência dessas lesões e estudos com foco nos gastos hospitalares e em reabilitação precisam ser realizados no Brasil para determinar o fardo socioeconômico do traumatismo vertebral e traumatismo medular.

RESUMEN Objetivo : Describir la epidemiología de los pacientes con fractura de columna toracolumbar sometidos a cirugía en el Hospital Cristo Redentor y los costos relacionados. Métodos : Estudio epidemiológico prospectivo entre julio de 2014 y agosto de 2015 de pacientes con fracturas de la columna toracolumbar con indicación de cirugía. Se analizaron las variables sexo, edad, costo de hospitalización, niveles fracturados, niveles de artrodesis, infección del sitio quirúrgico, ITU o BCP, lesión de la médula espinal, etiología, duración de la estancia hospitalaria, tiempo del procedimiento y la escala visual analógica (EVA). Resultados: Fueron evaluados 32 pacientes durante el período de estudio, con un promedio de edad de 38,68 años. La relación entre hombres y mujeres fue de 4:1 y las causas más frecuentes fueron las caídas de altura (46,87%) y los accidentes de tránsito (46,87%). La transición toracolumbar fue la más afectada (40,62%) con la vértebra de L1 involucrada en 23,8% de los casos. Presentaron déficit neurológico 40,62% de los pacientes. La estancia hospitalaria tuvo mediana de 14 días y los pacientes con déficit neurológico permanecieron hospitalizados por un período más largo (p <0,001), con un aumento de los gastos de hospital (p= 0,015). El costo promedios de hospitalización fue de U$ 2.874,80. La presencia de BCP aumentó el costo de la hospitalización y los pacientes con lesión de la médula espinal tuvieron más BCP (p= 0,014) . Conclusión : Políticas públicas, con énfasis en la reducción de los accidentes de tránsito y las caídas pueden ayudar a reducir la incidencia de estas lesiones y los estudios centrados en los costos hospitalarios y de rehabilitación deben ser llevados a cabo en Brasil para determinar la carga socioeconómica del trauma espinal y la lesión de médula espinal.

Cost effectiveness of different techniques in hallux valgus surgery.

BACKGROUND: Different surgical techniques are available to correct each type of Hallux Valgus (HV) deformity, and all present similar good results. No information is available relative to the cost of each technique compared to their individual success. OBJECTIVE: To determine the cost-effectiveness-ratio (CER) of five different techniques for HV. METHODS: We included 245HV surgeries performed in 179 patients. The severity was defined according to radiological parameters. For mild to moderate HV we included the Chevron, Modified-Scarf and Ludloff techniques; for severe HV: either Poscow-osteotomy or Lapidus-arthrodesis fixed with plates or screws. Weighted costs were estimated. CER was expressed in $US dollars per AOFAS-point. RESULTS: The lowest weighted cost was observed for the Chevron-group, and the highest weighted cost was observed in the Poscow-osteotomy and Lapidus-arthrodesis fixed with plate groups. The AOFAS-score improvement was higher in the Chevron and Modified-Scarf groups. The CER found for Chevron and Modified-Scarf techniques were significantly less than for Poscow and Lapidus-techniques. CONCLUSION: Cost-Effectiveness-Ratio was lower, and therefore better, in the groups with mild to moderate deformities operated with Chevron or Modified-Scarf techniques. In severe HV, the three techniques investigated presented similar CER. CER analysis is an additional factor that can be included in the decision making analysis in hallux valgus surgery. Level of Evidence Level IV, Retrospective Study.