Economic impact of periprosthetic hip fractures / Impacto económico de las fracturas periprotésicas de cadera

Introduction: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. Methods: The study included all patients admitted between 2009 and 2019 with a diagnosis of “PPHF”. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. Results: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45–92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). Conclusions: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.(AU)

Introducción: La artroplastia de cadera es una de las operaciones con mejores resultados en cirugía ortopédica. Las fracturas periprotésicas de cadera (FPPC) tienen consecuencias muy graves para el paciente y además suponen un impacto económico muy importante para los sistemas sanitarios. El objetivo del estudio es realizar el primer análisis detallado de los costes de las FPPC en un Servicio de Cirugía Ortopédica y Traumatología en un hospital universitario de tercer nivel en España. Métodos: El estudio incluyó a todos los pacientes ingresados entre 2009 y 2019 con el diagnóstico de «FPPC». Se evaluaron el coste de la estancia hospitalaria, el coste total del quirófano, el coste de los implantes utilizados, los análisis de sangre, las consultas con otros especialistas, las sesiones de rehabilitación, las pruebas radiológicas, la microbiología, las transfusiones de sangre y otras intervenciones quirúrgicas durante el mismo ingreso. Resultados: Se incluyó a un total de 78 pacientes, 49 mujeres y 29 hombres, con una edad media de 78,74 años (R 45-92); 69 pacientes recibieron tratamiento quirúrgico, el 75% se sometió a reducción abierta y fijación interna (RAFI) y el 25% a revisión protésica. El coste total fue de 1.139.650,17 €. El coste medio fue de 14.610,90 €. Los costes fueron significativamente más elevados en la revisión protésica que en la RAFI, en los ingresos que duraron más de 30 días y en los pacientes que requirieron más de una intervención quirúrgica durante el ingreso. Los factores que más influyeron en el coste fueron la estancia hospitalaria (46%), el coste de la intervención quirúrgica (35%) y el de los implantes (24%). Conclusiones: La cirugía de revisión protésica frente a RAFI, los ingresos de más de 30 días y los pacientes que requirieron más de una intervención quirúrgica durante el ingreso supusieron costes significativamente mayores. El coste medio, desde el punto de vista hospitalario, generado por una FPPC fue de 14.610,90 €.(AU)

[Artículo traducido] Impacto económico de las fracturas periprotésicas de cadera / Economic impact of periprosthetic hip fractures

Introduction: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. Methods: The study included all patients admitted between 2009 and 2019 with a diagnosis of “PPHF”. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. Results: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45–92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). Conclusions: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.(AU)

Introducción: La artroplastia de cadera es una de las operaciones con mejores resultados en cirugía ortopédica. Las fracturas periprotésicas de cadera (FPPC) tienen consecuencias muy graves para el paciente y además suponen un impacto económico muy importante para los sistemas sanitarios. El objetivo del estudio es realizar el primer análisis detallado de los costes de las FPPC en un Servicio de Cirugía Ortopédica y Traumatología en un hospital universitario de tercer nivel en España. Métodos: El estudio incluyó a todos los pacientes ingresados entre 2009 y 2019 con el diagnóstico de «FPPC». Se evaluaron el coste de la estancia hospitalaria, el coste total del quirófano, el coste de los implantes utilizados, los análisis de sangre, las consultas con otros especialistas, las sesiones de rehabilitación, las pruebas radiológicas, la microbiología, las transfusiones de sangre y otras intervenciones quirúrgicas durante el mismo ingreso. Resultados: Se incluyó a un total de 78 pacientes, 49 mujeres y 29 hombres, con una edad media de 78,74 años (R 45-92); 69 pacientes recibieron tratamiento quirúrgico, el 75% se sometió a reducción abierta y fijación interna (RAFI) y el 25% a revisión protésica. El coste total fue de 1.139.650,17 €. El coste medio fue de 14.610,90 €. Los costes fueron significativamente más elevados en la revisión protésica que en la RAFI, en los ingresos que duraron más de 30 días y en los pacientes que requirieron más de una intervención quirúrgica durante el ingreso. Los factores que más influyeron en el coste fueron la estancia hospitalaria (46%), el coste de la intervención quirúrgica (35%) y el de los implantes (24%). Conclusiones: La cirugía de revisión protésica frente a RAFI, los ingresos de más de 30 días y los pacientes que requirieron más de una intervención quirúrgica durante el ingreso supusieron costes significativamente mayores. El coste medio, desde el punto de vista hospitalario, generado por una FPPC fue de 14.610,90 €.(AU)

Economic impact of periprosthetic hip fractures. / [Artículo traducido] Impacto económico de las fracturas periprotésicas de cadera.

INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of «PPHF¼. We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: Seventy-eight patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). Sixty-nine patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1 139 650.17. The average cost was €14 610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14 610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.

Economic impact of periprosthetic hip fractures.

INTRODUCTION: Hip replacement is one of the most successful operations in orthopaedic surgery. Periprosthetic hip fractures (PPHF) have very serious consequences for the patient, and they also entail a very important economic impact on healthcare systems. The aim of the study was to provide the first detailed cost analysis of PPHF in a traumatology and orthopaedics service in a third level hospital in Spain. METHODS: The study included all patients admitted between 2009 and 2019 with a diagnosis of "PPHF". We assessed hospital stay cost, total cost of the operating theatre, cost of the implants used, analyses, consultations with other specialists, rehabilitation sessions, radiological tests, microbiology, blood transfusions and other surgical operations during the same admission. RESULTS: 78 patients were included in the study, 49 women and 29 men, with a mean age of 78.74 years (R 45-92). 69 patients received surgical treatment, 75% had open reduction and internal fixation (ORIF), and 25% had revision surgery. The total cost was €1,139,650.17. The average cost was €14,610.90. Significantly higher costs were incurred for revision compared to ORIF treatments, admissions that lasted more than 30 days, and patients who required more than one operation during admission. The most costly factors were the hospital stay (46%), the cost of the surgery itself (35%), and the implants (24%). CONCLUSIONS: Revision arthroplasty versus ORIF treatment, admissions lasting more than 30 days, and patients requiring more than one operation on admission incurred significantly higher costs. The average cost, from a hospital perspective, generated by a PPHF was €14,610.90. The most costly factors were, in descending order, the hospital stay, the cost of the surgery itself, and the implants. It is necessary to establish protocols and updated therapeutic algorithms in the perioperative management of PPHF in order to reduce both morbidity rates and associated costs.

[Calcaneal fractures: controversies and consensus]. / Fracturas de calcáneo: controversias y consensos.

Calcaneal fractures are the most common tarsal fractures and their treatment is still debated today. We intend in this update to highlight the points of controversy and clarify the consensus, especially in the treatment of intra-articular fractures, as well as to describe the management of major complications.

Las fracturas de calcáneo son las más frecuentes del tarso y su tratamiento sigue siendo hoy en día objeto de debate. Pretendemos en esta actualización destacar los puntos de controversia, así como clarificar los consensos, especialmente en el tratamiento de las fracturas intraarticulares, así como describir el manejo de las principales complicaciones.

Fracturas de calcáneo: controversias y consensos / Calcaneal fractures: controversies and consensus

Resumen: Las fracturas de calcáneo son las más frecuentes del tarso y su tratamiento sigue siendo hoy en día objeto de debate. Pretendemos en esta actualización destacar los puntos de controversia, así como clarificar los consensos, especialmente en el tratamiento de las fracturas intraarticulares, así como describir el manejo de las principales complicaciones.

Abstract: Calcaneal fractures are the most common tarsal fractures and their treatment is still debated today. We intend in this update to highlight the points of controversy and clarify the consensus, especially in the treatment of intra-articular fractures, as well as to describe the management of major complications.

Monitorización neurofisiológica intraoperatoria en la cirugía del nervio periférico: descripción técnica y resultados en nuestro centro / Intraoperative neurophysiological monitoring in peripheral nerve surgery: technical description and experience in a centre

Introducción. La monitorización neurofisiológica intraoperatoria ha experimentado un espectacular desarrollo en los últimos 20 años, particularmente en campos como la neurocirugía y la cirugía de raquis. Se ha constituido en una herramienta muy útil en la prevención de daño neurológico durante la cirugía, si bien su utilidad en la cirugía del nervio periférico en el área de traumatología y ortopedia no ha sido constatada. Objetivo. Describir exhaustivamente la técnica de monitorización neurofisiológica intraoperatoria y secundariamente comunicar la experiencia de nuestro centro. Pacientes y método. Estudio descriptivo retrospectivo de 30 casos de cirugía de nervio periférico realizadas en nuestro centro en el período 2009-2013. Descripción pormenorizada de la técnica de monitorización neurofisiológica intraoperatoria utilizada. Resultados. Registramos 13 tumores del nervio periférico, de estos, obtuvimos 11 resultados excelentes y 2 buenos, uno con hipoestesia temporal y otro con recuperación motora casi completa aunque no sensitiva. Registramos 17 casos de lesiones traumáticas, en 6 casos fue necesaria la realización de injerto, en los 11 restantes solo realizamos neurolisis, con recuperación sensitiva y motora completa. Conclusiones. La monitorización neurofisiológica intraoperatoria supone una herramienta útil en la cirugía secundaria de las lesiones del nervio periférico y en la enfermedad tumoral intraneural de dicho nervio (AU)

Introduction. Intraoperative neurophysiological monitoring has experienced a spectacular development in the past 20 years, particularly in the fields of neurosurgery and spine surgery. it has become a useful, almost indispensable, tool in preventing nerve damage during surgery. The aim of this article is to describe the intraoperative technique and analyze its results in the field of peripheral nerve surgery. Objective. To describe the usefulness of a technique in peripheral nerve surgery, the technique used and the experience in a centre. Patients and methods. A retrospective study was conducted on 30 cases of peripheral nerve surgery performed in this centre from 2009 to 2013, using the intraoperative monitoring technique. Results. Of the total of 13 peripheral nerve tumors recorded, there were 11 excellent results and 2 good results, one temporary hypoesthesia and one with almost complete sensory, except for motor, recovery. Traumatic injury was recorded in 17 cases, of which 6 required performing a graft, and the remaining 11 cases only neurolysis was performed, with complete motor and sensory recovery. Conclusions. Intraoperative neurophysiological monitoring is a useful tool in the secondary surgery of peripheral nerve injury and the intraneural tumor pathology (AU)

Intraoperative neurophysiological monitoring in peripheral nerve surgery: Technical description and experience in a centre.

INTRODUCTION: Intraoperative neurophysiological monitoring has experienced a spectacular development in the past 20 years, particularly in the fields of neurosurgery and spine surgery. it has become a useful, almost indispensable, tool in preventing nerve damage during surgery. The aim of this article is to describe the intraoperative technique and analyze its results in the field of peripheral nerve surgery. OBJECTIVE: To describe the usefulness of a technique in peripheral nerve surgery, the technique used and the experience in a centre. PATIENTS AND METHODS: A retrospective study was conducted on 30 cases of peripheral nerve surgery performed in this centre from 2009 to 2013, using the intraoperative monitoring technique. RESULTS: Of the total of 13 peripheral nerve tumors recorded, there were 11 excellent results and 2 good results, one temporary hypoesthesia and one with almost complete sensory, except for motor, recovery. Traumatic injury was recorded in 17 cases, of which 6 required performing a graft, and the remaining 11 cases only neurolysis was performed, with complete motor and sensory recovery. CONCLUSIONS: Intraoperative neurophysiological monitoring is a useful tool in the secondary surgery of peripheral nerve injury and the intraneural tumor pathology.