title: Costs and coding--free-flap reconstruction in lower-limb trauma.
abstract: BACKGROUND
  The provision of a complex lower-limb trauma service has significant resource implications. This financial burden is not recognised by the current fixed price tariff system (Payment by Results). The aim of this study was to compare the actual costs of treatment with reimbursement.
  
  
  METHODS
  We conducted a prospective study in two large regional plastic surgery centres in the UK, Salisbury Foundation Trust (SFT) and the Frenchay Hospital, Bristol (FH). The total cost of treatment for consecutive patients with complex lower limb trauma requiring free tissue transfer was calculated and compared with the Health Resource Group (HRG) tariff.
  
  
  RESULTS
  A cost analysis was performed on 20 patients (10 Salisbury, 10 Frenchay) with open tibial fractures (all grade IIIb Gustillo & Anderson) requiring free-flap reconstruction (15 anterolateral thigh (ALT) flaps, one serratus, one latissimus dorsi (LD), one scapular and two gracilis). The mean treatment cost of performing a free flap was £12792 ± £970 SEM (SFT) and £10953 ± £650 (FH). In both centres, the cost was more than double the HRG tariff (£4220 SFT, £4892 FH, p < 0.05).
  
  
  CONCLUSIONS
  Our study highlights the considerable disparity between the cost of managing patients with severe lower-limb trauma and the remuneration by Primary Care Trusts (PCTs). Accurate cost analysis of these cases will allow hospital trusts to negotiate appropriate tariffs with PCTs and develop services, which are cost neutral.
authors.affiliation: Odstock Centre for Burns, Plastic and Reconstructive Surgery, Salisbury Foundation Trust, Salisbury SP2 8BJ, UK. willtownley@hotmail.com
authors.forename: W A
authors.initials: WA
authors.lastname: Townley
authors.forename: C
authors.initials: C
authors.lastname: Urbanska
authors.forename: R L R
authors.initials: RL
authors.lastname: Dunn
authors.forename: U
authors.initials: U
authors.lastname: Khan
mesh_terms: D000328:Adult; D059019:Clinical Coding; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000379:methods; D013524:Surgical Flaps / Q000191:economics*; D013978:Tibial Fractures / Q000191:economics* / Q000601:surgery