Delay to operative treatment of femoral fractures in the province of Quebec - effects on complications and cost of care

Waiting time to access medical care in Canada is 20% more than the international average. Delayin instituting care in trauma patients has been shown to be associated with higher complicationrates and an increase in mortality. Whenever complications occur during patient care, it usuallyresults in increased cost of care. Femur fractures constitute about 11% of all fractures and areusually treated operatively. Delay in operative treatment is a source of distress to these patientsand a major factor for poor outcome. Knowledge gaps exist for statistics on operative delay tofixation of isolated femur fractures and the influence on complications and cost of treatment.This study describes (1) the burden and effect of delay to operative fixation of fractures of thefemur on the occurrence of complications as well as on the overall cost of care in hospitals withinthe Province of Quebec. Other objectives include: (2) to compare reoperation rates between adultpatients with and without delayed surgeries. (3) To propose a time frame within which femurfractures should be operatively treated in order to minimize the risk of complications and to reducetreatment cost.6,520 adult patients operatively treated for closed femoral fractures between July 1993 andDecember 2002 were recruited into this study. Data was accessed from the Quebec TraumaRegistry, the MED-ECHO and the RAMQ databases of costs for medical treatments. Detailsobtained from the registry included: demographic information of the patients, time of injury andother details of the injury, time of arrival in the emergency room, Injury Severity Score (ISS), typeand location of the femur fracture, and method/type of operative fracture stabilization. Outcomemeasures included length of hospital stay, cost of treatment, re-operations and early post-operativecomplications. Patients with poly-trauma, open fractures, fractures occurring in diseased bone andthose with missed diagnosis for longer than one week were excluded.Data analysis was carried out using the SPSS software version 17.0. Cases were stratified basedon the parts of the femur that are fractured. Cost analysis was carried out using parametrictechniques based on the Student’s t-test and the generalized longitudinal model.Operative delay to fracture stabilization was associated with increased complications, ICU stay,LOS and increased costs of hospitalization as well as out-patient follow-up treatment. There wasa progressive increase in the tendency to these adverse events which was quite significant after thefirst 48 hours of delay. Injury severity scores (ISS) >15 was another factor which predisposed toprolonged ICU stay, LOS and increased cost of treatment. Femur fractures, irrespective of whichpart of the bone was involved, were commoner in over-65 year-olds and women.This study identified the major cost drivers of operative treatment of femur fractures namely,ISS>15, operative delay ≥48 hours, occurrence of complications, and re-operations. Efforts atminimizing operative delay in femur fractures will help not only to mitigate patient suffering, butalso bring about a reduction in the cost of treatment and follow-up

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.