Resource Utilization and Cost Associated With Hand Trauma: An Analysis Outside of the Surgical Global Period

Purpose

Hand injuries constitute approximately 20% of emergency department visits. Some of these injuries may require surgical care and extended follow-up outside of the global surgery period to obtain the best functional outcomes. However, little is known regarding national estimates of health care utilization outside of the global period and the characteristics and associated expenses of these services.

Methods

We conducted a retrospective, population-based analysis of patients using the Merative MarketScan Research Database between 2019 and 2022 for “treatment intense” hand trauma including distal radius fracture surgical treatment, flexor tendon repair, and replantation/revascularization. We evaluated health care utilization from 90 days to 1 year after the index operation and the associated payments and out-of-pocket expenses.

Results

There was a total of 20,141 patients identified from the database. Between 90 days and 1 year after the index procedure, 1,361 (6.8%) patients had at least one utilization visit while 18,780 (93.2%) patients had no utilization visits. This resulted in mean total payments of $934.31 for care from 91 to 365 days after the index operation, whereas mean out-of-pocket expenses were $89.89. Patients with at least one utilization visit were more likely to be older (51 vs 50 years), have a median household income between <40,000 to 60,000, and underwent treatment for a distal radius fracture or replantation. Additionally, flexor tendon repair was associated with a decreased adjusted mean of total insurance payments (odds ratio [OR], 0.57 [0.42–0.81]), compared to distal radius fracture fixation.

Conclusions

Hand traumatic injuries are resource-intensive and may require treatment outside the global period to obtain the best functional outcomes. Findings from this study provide national estimates of the health care utilization outside of the global period and the associated costs to the health care systems and patients.

Type of study/level of evidence

Economic II.