Extracapsular hip fracture management: cost-consequences analysis of two alternative operative methods.
OBJECTIVE
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.


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 euro 1,931 per case, whereas for those treated with hemiarthroplasty reached euro 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.
Papakonstantinou
Vassiliki V
VV
University of Athens, Athens, Greece. bpapakost@nurs.uoa.gr
Kaitelidou
Daphne
D
Gkolfinopoulou
Kassiani D
KD
Siskou
Olga Ch
OCh
Papapolychroniou
Theodoros
T
Baltopoulos
Panagiotis
P
Liaropoulos
Lycourgos
L
D000203:Activities of Daily Living; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics; D006620:Hip Fractures / Q000401:mortality / Q000601:surgery*; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000191:economics* / Q000379:methods*; D011183:Postoperative Complications / Q000191:economics; D011446:Prospective Studies