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Multicenter Study
. 2024 Oct;50(5):2605-2613.
doi: 10.1007/s00068-024-02637-1. Epub 2024 Aug 26.

The economic impact of open lower limb fractures in the Netherlands: a cost-of-illness study

M P Noorlander-Borgdorff  1   2 , W Kievit  3 , G F Giannakópoulos  4 , M Botman  5 , T N Tromp  6 , K Oflazoglu  5 , H A Rakhorst  7 , T de Jong  8
Affiliations
Multicenter Study

The economic impact of open lower limb fractures in the Netherlands: a cost-of-illness study

M P Noorlander-Borgdorff et al. Eur J Trauma Emerg Surg. 2024 Oct.

Abstract

Purpose: To estimate the one-year sum of direct costs related to open lower limb fracture treatment in an academic setting in the Netherlands. The secondary objective was to estimate the impact of deep infection and nonunion on one-year total direct costs.

Methods: A multi-center, retrospective cost analysis of open lower limb fractures treated in an academic setting in the Netherlands, between 1 January 2017 and 31 December 2018, was conducted. The costing methodology was based on patient level aggregation using a bottom-up approach. A multiple linear regression model was used to predict the total costs based on Fracture-related-infections, multitrauma, intensive care unit (ICU) admission, Gustilo-Anderson grade and nonunion.

Results: Overall, 70 fractures were included for analysis, the majority Gustilo-Anderson grade III fractures (57%). Median (IQR) one-year hospital costs were €31,258 (20,812-58,217). Costs were primarily attributed to the length of hospital stay (58%) and surgical procedures (30%). The median length of stay was 16 days, with an increase to 50 days in Fracture-related infections. Subsequent costs (46,075 [25,891-74,938] vs. 15,244 [8970-30,173]; p = 0.002), and total hospital costs (90,862 [52,868-125,004] vs. 29,297 [21,784-40,677]; p < 0.001) were significantly higher for infected cases. It was found that Fracture-related infection, multitrauma, and Gustilo-Anderson grade IIIA-C fractures were significant predictors of increased costs.

Conclusion: In treatment of open lower limb fractures, deep infection, higher Gustilo-Anderson classification, and multitrauma significantly increase direct hospital costs. Considering the impact of infection on morbidity and total healthcare costs, future research should focus on preventing Fracture-related infections.

Keywords: Costs analysis; Healthcare financing; Lower limb reconstruction; Open fractures.

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Conflict of interest statement

Declarations. Conflict of interest: The authors of this article declare that they have no known competing financial interests, nor personal relationships that could have influenced the work and outcomes of this paper. The authors declare no competing interests. Ethical approval: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committees.

Figures

Fig. 1
Fig. 1
Cost categories of direct hospital costs in open lower limb fracture treatment
Fig. 2
Fig. 2
Fracture-related infections (FRI) and the direct one year hospital costs per category
See this image and copyright information in PMC

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