Health Care Usage and Related Costs in Fibular Plating for AO Type 44-B Ankle Fractures in a Belgian University Hospital: An Exploratory Analysis

Abstract

Open reposition and internal fixation (ORIF) is the reference standard for unstable Arbeitsgemeinschaft für Osteosynthesefragen (AO)-type 44-B ankle fractures. Age, comorbidity, delayed-staged surgery, and length-of-stay (LOS) are all factors that presumably correlate positively with health care costs. We performed an exploratory analysis of the health care costs associated with the treatment of this type of fracture and hypothesized that these costs will be significantly greater for the elderly. A total of 217 patients with an acute AO type 44-B ankle fracture were included. We studied 14 variables, and 5 main cost categories were defined. The health care costs associated with the treatment of ankle fractures in the present study constituted more than one half (53%) of the hospitalization costs, which, in turn, were strongly related to the LOS. Delayed-staged surgery and age were the most important clinical variables driving the total health care costs and LOS (p < .001). The median LOS before ORIF was 6 times greater (12 versus 2 days) for patients treated using a delayed-staged surgery protocol. The cutoff age above which the costs differed significantly was 65 years. Thus, the median total health care costs for the treatment of these fractures were doubled in the older group ($9207 versus $4559), mainly owing to a 2 times greater LOS before ORIF (2 versus 4 days) and 3 times greater total LOS (4 versus 12.5 days) in the elderly. Surprisingly, the complication rate was equal (27.7% versus 29.3%) in the 2 groups. Therefore, to decrease the total health care costs, we should focus on a reduction of the costly LOS before ORIF in the elderly population.

Keywords: ankle fractures; cost of illness; costs and costs analysis; fibular nailing; fracture open reduction and internal fixation; health care financing.