Variations in Treatment and Costs for Distal Radius Fractures in Patients Over 55 Years of Age: A Population-Based Study.

IF 0.3 Q4 SURGERY
Journal of Hand and Microsurgery Pub Date : 2022-07-05 eCollection Date: 2023-12-01 DOI:10.1055/s-0042-1749460
Lauren M Shapiro, Michelle Xiao, Thompson Zhuang, David S Ruch, Marc J Richard, Robin N Kamal
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Abstract

Objective  To evaluate the rate of surgery for symptomatic malunion after nonoperatively treated distal radius fractures in patients aged 55 and above, and to secondarily report differences in demographics, geographical variation, and utilization costs of patients requiring subsequent malunion correction. Methods  We identified patients aged 55 and above who underwent nonoperative treatment for a distal radius fracture between 2007 and 2016 using the IBM MarketScan database. In the nonoperative cohort, we identified patients who underwent malunion correction between 3 months and 1 year after distal radius fracture. The primary outcome was rate of malunion correction. Multivariable logistic regression controlling for sex, region, and Elixhauser Comorbidity Index (ECI) was used. We also report patient demographics, geographical variation, and utilization cost. Results  The rate of subsequent malunion surgery after nonoperative treatment was 0.58%. The cohort undergoing malunion surgery was younger and had a lower ECI. For every 1-year increase in age, there was a 6.4% decrease in odds of undergoing surgery for malunion, controlling for sex, region, and ECI (odds ratio = 0.94 [0.93-0.95]; p  < 0.01). The southern United States had the highest percentage of patients initially managed operatively (30.7%), the Northeast had the lowest (22.0%). Patients who required a malunion procedure incurred higher costs compared with patients who did not ($7,272 ± 8,090 vs. $2,209 ± 5,940; p  < 0.01). Conclusion  The rate of surgery for symptomatic malunion after initial nonoperative treatment for distal radius fractures in patients aged 55 and above is low. As younger and healthier patients are more likely to undergo malunion correction with higher associated costs, surgeons may consider offering this cohort surgical treatment initially.

55 岁以上患者桡骨远端骨折的治疗方法和成本差异:基于人口的研究。
目的 评估 55 岁及以上桡骨远端骨折患者在接受非手术治疗后因症状性畸形而接受手术治疗的比例,其次报告需要进行后续畸形矫正的患者在人口统计学、地域差异和使用成本方面的差异。方法 我们利用 IBM MarketScan 数据库确定了 2007 年至 2016 年期间因桡骨远端骨折接受非手术治疗的 55 岁及以上患者。在非手术队列中,我们确定了在桡骨远端骨折后 3 个月至 1 年间接受过畸形矫正的患者。主要结果是畸形矫正率。我们采用了控制性别、地区和埃利克豪斯综合症指数(ECI)的多变量逻辑回归。我们还报告了患者人口统计学、地域差异和使用成本。结果 非手术治疗后的后续畸形手术率为 0.58%。接受错位手术的人群年龄较轻,ECI较低。在控制了性别、地区和 ECI 的情况下,年龄每增加 1 岁,因畸形接受手术的几率就会降低 6.4%(几率比 = 0.94 [0.93-0.95];p p 结论 55 岁及以上的桡骨远端骨折患者在初次非手术治疗后因症状性畸形接受手术的比例较低。由于更年轻、更健康的患者更有可能接受愈合不良矫正术,而相关费用也会更高,因此外科医生可以考虑首先为这部分患者提供手术治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
1.00
自引率
25.00%
发文量
39
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