Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-23T08:53:05.007Z Has data issue: false hasContentIssue false
  • English
  • Français

Extracapsular hip fracture management: Cost-consequences analysis of two alternative operative methods

Published online by Cambridge University Press:  09 April 2008

Vassiliki V. Papakonstantinou ,
Daphne Kaitelidou ,
Kassiani D. Gkolfinopoulou ,
Olga Ch. Siskou ,
Theodoros Papapolychroniou ,
Panagiotis Baltopoulos  and
Lycourgos Liaropoulos
Vassiliki V. Papakonstantinou
Affiliation:
University of Athens
Daphne Kaitelidou
Affiliation:
University of Athens
Kassiani D. Gkolfinopoulou
Affiliation:
University of Peloponnese and Hellenic Center for Disease Control & Prevention
Olga Ch. Siskou
Affiliation:
University of Athens
Theodoros Papapolychroniou
Affiliation:
NIMTS Hospital
Panagiotis Baltopoulos
Affiliation:
University of Athens and KAT Hospital
Lycourgos Liaropoulos
Affiliation:
University of Athens
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this prospective study was to perform a cost and outcome comparison between two alternative operative techniques (osteosynthesis and hemiarthroplasty) used in the treatment of elderly patients with unstable trochanteric hip fracture.

Materials and Methods: One hundred seventy-three trochanteric hip fracture patients were followed-up for 1 year after surgery. For each operative technique, hospital treatment's cost per patient was computed. Mortality and complication rate in-hospital and at specific time points after surgery were used as outcome measures. Patients' functional level before and after hip fracture was estimated according to their mobility and ability to perform basic and instrumental activities of daily living.

Results: The cost for patients undergoing osteosynthesis reached €1,931 per case, whereas for those treated with hemiarthroplasty reached €3,719 per case (2001 rates). There was no statistically significant difference regarding in-hospital mortality and complication rate, as well as mortality and complication rate 1 year after surgery, between the two patient groups.

Conclusions: The quite similar performance of the two operative techniques suggests that cost could be the key factor for choosing between them. However, it is critical that many more randomized studies, with larger sample sizes and wider follow-up time periods should be conducted.

Keywords

CostExtracapsular hip fractureHemiarthroplastyMortalityOsteosynthesis
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 2 , April 2008 , pp. 221 - 227
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Broos, PL, Rommens, PM, Deleyn, PR, Geens, VR, Stappaerts, KH. Pertrochanteric fractures in the elderly: Are there indications for primary prosthetic replacement? J Orthop Trauma. 1991;5:446–451.Google Scholar
2. Chan, K, Gill, G. Cemented hemiarthroplasties for elderly patients with intertrochanteric fractures. Clin Orthop. 2000;371:206–215.Google Scholar
3. Dolk, T. Influence of treatment factors on the outcome after hip fractures. Ups J Med Sci. 1989;94:209–221.CrossRefGoogle ScholarPubMed
4. Drummond, M, O' Brien, B, Stoddart, GL, Torrance, GW. Methods for the economic evaluation of health care programmes. 2nd ed. New York: Oxford Medical Publications; 1998.Google Scholar
5. Haentjens, P, Casteleyn, PP, De Boeck, H, Handelberg, F, Opdecam, P. Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am. 1989;71:1214–1225.CrossRefGoogle ScholarPubMed
6. Hoffer, M, Feiwell, E, Perry, R, et al. Functional ambulation in patients with myelomeningocele. J Bone Joint Surg Am. 1973;55:137–148.CrossRefGoogle ScholarPubMed
7. Hollingworth, W, Todd, C, Parker, M. Cost analysis of early discharge after hip fracture. BMJ. 1993;307:903–906.Google Scholar
8. Jacobs, MJ, Markel, DC. Geriatric intertrochanteric hip fractures: An economic analysis. Am J Orthop. 1999;28:573–576.Google Scholar
9. Kaitelidou, D, Ziroyanis, P, Maniadakis, N, Liaropoulos, L. Economic evaluation of hemodialysis: Implications for technology assessment in Greece. Int J Techol Assess Health Care. 2005;21:40–46.CrossRefGoogle ScholarPubMed
10. Katz, S, Akbom, CA. A measure of primary sociobiological functions. Int J Health Serv. 1976;6:493–507.CrossRefGoogle ScholarPubMed
11. Kenzora, JE, McCarthy, RE, Lowell, JD, Sledge, CB. Hip fracture mortality. Relation to age, treatment, preoperative illness, time of surgery and complications. Clin Orthop. 1984;86:45–56.Google Scholar
12. Koval, KJ, Skovron, ML, Aharonoff, GB, Meadows, SE, Zuckerman, JD. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop. 1995;310:150–159.Google Scholar
13. Koval, KJ, Skovron, ML, Aharonoff, GB, Zuckerman, JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop. 1998;348:22–2814.Google Scholar
14. Lawrence, TM, White, CT, Wenn, R, Moran, CG. The current hospital costs of treating hip fractures. Injury. 2005;36:88–91.CrossRefGoogle ScholarPubMed
15. Lawton, MP, Broody, E. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist. 1979;9:179–186.CrossRefGoogle Scholar
16. Lippuner, K, von Overbeck, J, Perrelet, R, Jaeger, P. Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Osteoporosis Int. 1997;7:414–425.CrossRefGoogle ScholarPubMed
17. Lopes Vaz, A. Epidemiology and costs of osteoporotic hip fractures in Portugal. Bone. 1993;14:S9.Google Scholar
18. Lyritis, G. Epidemiology and socioeconomic cost of osteoporotic fractures in Greece. Calcif Tissue Int. 1992;51:93–4.Google Scholar
19. Magaziner, J, Simonsick, EM, Kashner, TM, Hebel, JR, Kenzora, JE. Survival experience of aged hip fracture patients. Am J Public Health. 1989;79:274–278.Google Scholar
20. Myers, AH, Robinson, EG, Natta, ML, et al. Hip fracture among elderly: Factors associated with in-hospital mortality. Am J Epidemiol. 1991;134:1128–1137.CrossRefGoogle ScholarPubMed
21. Shah, MR, Aharonoff, GB, Wolinsky, P, et al. Outcome after hip fracture in individuals ninety years of age and older. J Orthop Trauma. 2001;15:34–39.CrossRefGoogle ScholarPubMed
22. Stappaerts, KH, Deldycke, J, Broos, PL, Staes, FF, Rommens, PM, Claes, P. Treatment of unstable peritrochanteric fractures in elderly patients with a compression hip screw or with the Vandeputte (VDP) endoprosthesis: A prospective randomized study. J Orthop Trauma. 1995;9:292–297.CrossRefGoogle ScholarPubMed
23. White, BL, Fisher, WD, Laurin, CA. Rate of mortality for elderly patients after fracture of the hip in the 1980's. J Bone Joint Surg Am. 1987;69:1335–1340.Google Scholar
24. Wiktorowicz, ME, Goeree, R, Papaioannou, A, et al. Economic implications of hip fracture: Health service use, institutional care and cost in Canada. Osteoporosis Int. 2001;12:271–278.Google Scholar
Supplementary material: File

Papakonstantinou supplementary material

Supplementary table

Download Papakonstantinou supplementary material(File)
File 42 KB