MEDLINE Abstracts: Economic Considerations of Treating Pediatric Femoral Fractures
MEDLINE Abstracts: Economic Considerations of Treating Pediatric Femoral Fractures
What's new concerning the cost of treatment for pediatric femoral fractures? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics.
Schnater JM, Sleeboom C, Raaymakers EL, Ekkelkamp S, Aronson DC
Nederlands Tijdschrift voor Geneeskunde 142(23):1324-1327, 1998 Jun 6
Objective: Evaluation of home traction as a treatment of femoral shaft fractures in children with the objective to shorten the hospital stay. DESIGN: Retrospective.
Setting: Paediatric Surgical Centre Amsterdam (EKZ/AMC and AZVU), the Netherlands.
Method: In the period 1991-1995, 18 femoral shaft fractures in children younger then 4 years were treated. In 10 of them, traction was applied at home (in the other cases the parents refused to cooperate, the home situation was not appropriate, there were additional medical problems, or there was a suspicion of child abuse). During follow-up of the group treated at home with traction, angulation, deformity and leg length discrepancy were determined with special attention to complications. The parents' experience of this method was evaluated by telephone (n=8).
Results: The median age of the children was 2.4 years. The mean hospital stay was 7 days (range, 3-12), the mean follow-up 2.4 years (range, 1.0-4.3). Angulation, rotational deformities, and leg length discrepancy >1 cm did not occur. Oedema and pain were seen in 1 patient as a result of incorrect treatment at home. In 1 patient a compartment syndrome occurred after a switch from traction to a plaster treatment in another hospital. With exception of some small practical and informational problems, parents were very pleased with this method.
Conclusion: Treatment at home of femoral shaft fractures in children with traction is a simple and effective method that reduces the hospital stay to 1 week with minimal complications. Good patient selection and instructions of the parents are mandatory.
Nork SE, Hoffinger SA
Journal of Orthopaedic Trauma 12(8):563-568, 1998 Nov-Dec
Objectives: To compare the hospital costs, charges, and reimbursement for treatment of pediatric femur fractures by 2 treatment methods: external fixation and 90-90 traction with spica casting.
Design: Retrospective clinical review.
Setting: Department of Orthopaedic Surgery, Children's Hospital Oakland, regional pediatric trauma center.
Patients: Twenty-nine consecutive patients between the ages of 5 and 10 with a fracture of the femoral shaft were treated by 1 of 2 methods: external fixation (16 patients) or 90-90 skeletal traction followed by spica casting (13 patients).
Intervention: External fixation or 90-90 traction followed by spica casting.
Main Outcome Measure: Hospital billing data including costs, charges, reimbursement for the initial inpatient hospitalization, and outpatient financial data until fracture union and cessation of treatment.
Results: There was no difference in age, total treatment time, mechanism of injury, or number of associated injuries between the 2 groups. The average charge for treatment with skeletal traction and spica casting was $32,094 per patient versus $21,439 for external fixation (P <0.001). The average cost for treatment with traction and spica casting was $22,396 per patient versus $11,520 for external fixation (P <0.001); reimbursement was $30,846 and $7,490, respectively (P <0.001). The number of days in the hospital was larger for the traction group than for the external fixation group (22.3 days versus 4.7 days, P <0.0001).
Conclusions: External fixation of pediatric femoral shaft fractures results in decreased hospital costs and length of hospitalization, but produces significantly less income for the hospital when compared with skeletal traction followed by spica casting.
Clinkscales CM, Peterson HA
Orthopedics (Thorofare, NJ) 20(12):1131-1136, 1997 Dec
The effectiveness of several treatment modalities for isolated closed femur fractures in children ages 4 through 16 years is compared based on outcome (clinical results, morbidity, and parents' satisfaction) and cost. Between 1986 and 1993, 30 patients were treated. Treatment methods included immediate hip spica cast application, distal femoral skeletal traction pin to align the fracture followed by early hip spica cast incorporating the pin (6th day), in-hospital traction, primary external fixation, and primary intramedullary nailing. Average follow up was 4.1 years. Overall results were excellent with minimal morbidity for all treatment methods. Early application of hip spica cast with or without incorporation of the distal femoral traction pin required the fewest hospital days, the shortest time to union, and had the lowest overall cost. Complications, mainly malunion and femoral length discrepancy, however, were greater. Skeletal traction resulted in the longest hospital stay and was equal in cost to external fixation and intramedullary nailing. Primary external fixation appears most applicable in patients who are unlikely to tolerate early casting and who are at increased risk of avascular necrosis with femoral nailing. Patients treated with an intramedullary nail had the fewest complications. Age, size, and gender of patient, location and type of fracture, as well as social circumstances are all significant factors in choosing the optimal method of treatment.
Coyte PC, Bronskill SE, Hirji ZZ, Daigle-Takacs G, Trerise BS, Wright JG
Clinical Orthopaedics & Related Research 336:205-215, 1997 Mar.
The purpose of this study was to assess the relative health system costs of early hip spica cast immobilization and external fixation for pediatric femoral shaft fractures. A cost analysis was performed from the viewpoint of the study hospital and physicians using protocols based on current practice. Cost estimates were based on patient and financial information from April 1, 1993, to January 31, 1994, including the fully allocated inpatient and outpatient costs. A sensitivity analysis was conducted to analyze the effect of complications on costs. Total estimated costs (in 1994 Canadian dollars, $1.00 = $0.75 US) of uncomplicated external fixation and hip spica treatments were $7626.30 and $5970.11, respectively. Fifty percent of this difference was attributable to longer inpatient stays for the external fixation treatment. The remaining difference was because of the cost of the fixator, additional operating room staff time costs, and additional professional and technical fees. Total expected costs of treatment complicated by loss of reduction, pin tract infection, and return to the operating room were $7716.01 and $6128.44 for the external fixation and hip spica treatment options, respectively. For the range of complication probabilities considered, expected total costs were always greater with the external fixation option than with the hip spica treatment.
What's new concerning the cost of treatment for pediatric femoral fractures? Find out in this easy-to-navigate collection of recent MEDLINE abstracts compiled by the editors at Medscape Orthopaedics.
Schnater JM, Sleeboom C, Raaymakers EL, Ekkelkamp S, Aronson DC
Nederlands Tijdschrift voor Geneeskunde 142(23):1324-1327, 1998 Jun 6
Objective: Evaluation of home traction as a treatment of femoral shaft fractures in children with the objective to shorten the hospital stay. DESIGN: Retrospective.
Setting: Paediatric Surgical Centre Amsterdam (EKZ/AMC and AZVU), the Netherlands.
Method: In the period 1991-1995, 18 femoral shaft fractures in children younger then 4 years were treated. In 10 of them, traction was applied at home (in the other cases the parents refused to cooperate, the home situation was not appropriate, there were additional medical problems, or there was a suspicion of child abuse). During follow-up of the group treated at home with traction, angulation, deformity and leg length discrepancy were determined with special attention to complications. The parents' experience of this method was evaluated by telephone (n=8).
Results: The median age of the children was 2.4 years. The mean hospital stay was 7 days (range, 3-12), the mean follow-up 2.4 years (range, 1.0-4.3). Angulation, rotational deformities, and leg length discrepancy >1 cm did not occur. Oedema and pain were seen in 1 patient as a result of incorrect treatment at home. In 1 patient a compartment syndrome occurred after a switch from traction to a plaster treatment in another hospital. With exception of some small practical and informational problems, parents were very pleased with this method.
Conclusion: Treatment at home of femoral shaft fractures in children with traction is a simple and effective method that reduces the hospital stay to 1 week with minimal complications. Good patient selection and instructions of the parents are mandatory.
Nork SE, Hoffinger SA
Journal of Orthopaedic Trauma 12(8):563-568, 1998 Nov-Dec
Objectives: To compare the hospital costs, charges, and reimbursement for treatment of pediatric femur fractures by 2 treatment methods: external fixation and 90-90 traction with spica casting.
Design: Retrospective clinical review.
Setting: Department of Orthopaedic Surgery, Children's Hospital Oakland, regional pediatric trauma center.
Patients: Twenty-nine consecutive patients between the ages of 5 and 10 with a fracture of the femoral shaft were treated by 1 of 2 methods: external fixation (16 patients) or 90-90 skeletal traction followed by spica casting (13 patients).
Intervention: External fixation or 90-90 traction followed by spica casting.
Main Outcome Measure: Hospital billing data including costs, charges, reimbursement for the initial inpatient hospitalization, and outpatient financial data until fracture union and cessation of treatment.
Results: There was no difference in age, total treatment time, mechanism of injury, or number of associated injuries between the 2 groups. The average charge for treatment with skeletal traction and spica casting was $32,094 per patient versus $21,439 for external fixation (P <0.001). The average cost for treatment with traction and spica casting was $22,396 per patient versus $11,520 for external fixation (P <0.001); reimbursement was $30,846 and $7,490, respectively (P <0.001). The number of days in the hospital was larger for the traction group than for the external fixation group (22.3 days versus 4.7 days, P <0.0001).
Conclusions: External fixation of pediatric femoral shaft fractures results in decreased hospital costs and length of hospitalization, but produces significantly less income for the hospital when compared with skeletal traction followed by spica casting.
Clinkscales CM, Peterson HA
Orthopedics (Thorofare, NJ) 20(12):1131-1136, 1997 Dec
The effectiveness of several treatment modalities for isolated closed femur fractures in children ages 4 through 16 years is compared based on outcome (clinical results, morbidity, and parents' satisfaction) and cost. Between 1986 and 1993, 30 patients were treated. Treatment methods included immediate hip spica cast application, distal femoral skeletal traction pin to align the fracture followed by early hip spica cast incorporating the pin (6th day), in-hospital traction, primary external fixation, and primary intramedullary nailing. Average follow up was 4.1 years. Overall results were excellent with minimal morbidity for all treatment methods. Early application of hip spica cast with or without incorporation of the distal femoral traction pin required the fewest hospital days, the shortest time to union, and had the lowest overall cost. Complications, mainly malunion and femoral length discrepancy, however, were greater. Skeletal traction resulted in the longest hospital stay and was equal in cost to external fixation and intramedullary nailing. Primary external fixation appears most applicable in patients who are unlikely to tolerate early casting and who are at increased risk of avascular necrosis with femoral nailing. Patients treated with an intramedullary nail had the fewest complications. Age, size, and gender of patient, location and type of fracture, as well as social circumstances are all significant factors in choosing the optimal method of treatment.
Coyte PC, Bronskill SE, Hirji ZZ, Daigle-Takacs G, Trerise BS, Wright JG
Clinical Orthopaedics & Related Research 336:205-215, 1997 Mar.
The purpose of this study was to assess the relative health system costs of early hip spica cast immobilization and external fixation for pediatric femoral shaft fractures. A cost analysis was performed from the viewpoint of the study hospital and physicians using protocols based on current practice. Cost estimates were based on patient and financial information from April 1, 1993, to January 31, 1994, including the fully allocated inpatient and outpatient costs. A sensitivity analysis was conducted to analyze the effect of complications on costs. Total estimated costs (in 1994 Canadian dollars, $1.00 = $0.75 US) of uncomplicated external fixation and hip spica treatments were $7626.30 and $5970.11, respectively. Fifty percent of this difference was attributable to longer inpatient stays for the external fixation treatment. The remaining difference was because of the cost of the fixator, additional operating room staff time costs, and additional professional and technical fees. Total expected costs of treatment complicated by loss of reduction, pin tract infection, and return to the operating room were $7716.01 and $6128.44 for the external fixation and hip spica treatment options, respectively. For the range of complication probabilities considered, expected total costs were always greater with the external fixation option than with the hip spica treatment.
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