Development of Compartment Syndrome Negatively Impacts Length of Stay and Cost After Tibia Fracture.

Abstract

OBJECTIVES:

To quantify the impact of compartment syndrome in the setting of tibial shaft fracture on hospital length of stay (LOS) and total hospital charges.

DESIGN:

Retrospective case-control study.

SETTING:

All New York State hospital admissions from 2001 to 2011, as recorded by the New York Statewide Planning and Research Cooperative System database.

PATIENTS:

Thirty three thousand six hundred twenty-nine inpatients with isolated open or closed fractures of the tibia and/or fibula (AO/OTA 41-43). Six hundred ninety-two patients developed a compartment syndrome in the setting of tibia fracture. All patients were filtered to ensure none had other complications or medical comorbidities that would increase LOS or total hospital charges.

INTERVENTION:

Fasciotomy and delayed closure in patients who developed a compartment syndrome.

MAIN OUTCOME MEASURE:

Hospital LOS (days) and total inflation-adjusted hospital charges.

RESULTS:

A total of 33,629 patients with tibial shaft fracture were included in the study. There were 32,937 patients who did not develop a compartment syndrome. For this group, the mean LOS was 6 days, and the mean inflation-adjusted hospital charges were $34,000. Patients who developed compartment syndrome remained in-house for an average of 14 days with average charges totaling $79,000. These differences were highly significant for both lengths of stay and hospital charges (P < 0.001).

CONCLUSIONS:

Besides the obvious physical detriment experienced by patients with compartment syndrome, there is also a significant economic impact to the healthcare system. Compartment syndrome after a tibial fracture more than doubles LOS and total hospital charges. These findings highlight the need for a standardized care algorithm aimed toward efficiently and adequately treating acute compartment syndrome. Such an algorithm would optimize cost of care and presumably decrease LOS.

LEVEL OF EVIDENCE:

Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

• Authors: Alexander M Crespo, Arthur Manoli 3rd, Sanjit R Konda, Kenneth A Egol
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 29 Issue 7 Pg. 312-5 (Jul 2015) ISSN: 1531-2291 [Electronic] United States
• PMID: 25463427 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Algorithms
• Case-Control Studies
• Compartment Syndromes (etiology, surgery)
• Dermatologic Surgical Procedures (economics, methods)
• Fasciotomy
• Female
• Health Care Costs (statistics & numerical data)
• Hospital Costs (statistics & numerical data)
• Humans
• Length of Stay (economics)
• Male
• Orthopedic Procedures (economics, methods)
• Outcome Assessment, Health Care
• Retrospective Studies
• Tibial Fractures (complications, surgery)
• Time Factors
• Treatment Outcome