title: The cost of after-hours operative debridement of open tibia fractures.
abstract: OBJECTIVE
  The aim of this study was to evaluate the additional cost associated with performing after-hours operative debridement of open fractures within 6 hours of injury.
  
  
  METHODS
  The economic model is based on population estimates obtained from the National Trauma Database and the National Inpatient Sample on the number of open tibia fractures that occur annually in the United States and the number that present after-hours (between 6 PM and 2 AM) that undergo operative debridement within 6 hours. This model estimates incremental cost for after-hours surgery based on overtime wages for on-call personnel (nurses and surgical technicians) required to staff after-hours cases as published by the US Department of Labor and data from our own institution. As many level 1 hospitals are capable of performing after-hours cases without additional cost, a sensitivity analysis was performed to determine the effect of designated level of care of the trauma hospital.
  
  
  METHODS
  A total of 17,414 open tibia fractures were recorded in the National Inpatient Sample for 2009, and an estimated 7485 open tibia fractures presented after-hours, 4242 of which underwent operative debridement within 6 hours of presentation. Based on wage statistics from the US Department of Labor and our own institution, the estimated total additional cost for after-hours operative debridement of open tibia fractures within 6 hours is from $2,210,895 to $4,046,648 annually, respectively. For level 2 hospitals and below, the cost of performing after-hours operative debridement of open tibia fractures is calculated as from $1,532,980 to $2,805,846 annually.
  
  
  CONCLUSIONS
  The data indicated an increased overall financial cost of performing after-hours operative debridement of open tibia fractures. Given that there is minimal documented benefit to this practice, and with increased pressure to practice cost containment, elective delay of operative debridement of open fractures and/or transfer to a higher level of care trauma hospital may be an acceptable way to address these issues.
  
  
  METHODS
  Economic analysis level III. See instructions for authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA; and †Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Mara L
authors.initials: ML
authors.lastname: Schenker
authors.forename: Jaimo
authors.initials: J
authors.lastname: Ahn
authors.forename: Derek
authors.initials: D
authors.lastname: Donegan
authors.forename: Samir
authors.initials: S
authors.lastname: Mehta
authors.forename: Keith D
authors.initials: KD
authors.lastname: Baldwin
mesh_terms: D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000191:economics* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005597:Fractures, Open / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013978:Tibial Fractures / Q000191:economics* / Q000453:epidemiology / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D055815:Young Adult