title: Can the use of an evidence-based algorithm for the treatment of intertrochanteric fractures of the hip maintain quality at a reduced cost?
abstract: In March 2012, an algorithm for the treatment of intertrochanteric fractures of the hip was introduced in our academic department of Orthopaedic Surgery. It included the use of specified implants for particular patterns of fracture. In this cohort study, 102 consecutive patients presenting with an intertrochanteric fracture were followed prospectively (post-algorithm group). Another 117 consecutive patients who had been treated immediately prior to the implementation of the algorithm were identified retrospectively as a control group (pre-algorithm group). The total cost of the implants prior to implementation of the algorithm was $357 457 (mean: $3055 (1947 to 4133)); compared with $255 120 (mean: $2501 (1052 to 4133)) after its implementation. There was a trend toward fewer complications in patients who were treated using the algorithm (33% pre- versus 22.5% post-algorithm; p = 0.088). Application of the algorithm to the pre-algorithm group revealed a potential overall cost saving of $70 295. The implementation of an evidence-based algorithm for the treatment of intertrochanteric fractures reduced costs while maintaining quality of care with a lower rate of complications and re-admissions.
authors.affiliation: NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, New York 10003, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Egol
authors.affiliation: NYU Hospital for Joint Diseases, 301 East 17th Street, New York, New York 10003, USA.
authors.forename: A I
authors.initials: AI
authors.lastname: Marcano
authors.affiliation: Upstate Medical School, Syracuse, New York, New York 13210, USA.
authors.forename: L
authors.initials: L
authors.lastname: Lewis
authors.affiliation: NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, New York 10003, USA.
authors.forename: N C
authors.initials: NC
authors.lastname: Tejwani
authors.affiliation: NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, New York 10003, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: McLaurin
authors.affiliation: NYU Hospital for Joint Diseases, 301 East 17th Street, New York, New York 10003, USA.
authors.forename: R I
authors.initials: RI
authors.lastname: Davidovitch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D017046:Cost Savings / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics / Q000379:methods* / Q000592:standards; D005594:Fracture Fixation, Intramedullary / Q000191:economics; D006620:Hip Fractures / Q000191:economics / Q000601:surgery*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Algorithm; Costs; Evidence-based; Extra-capsular; Femoral fracture; Gainsharing.; Hip fracture; Intertrochanteric; Intramedullary nail; OTA 31-A; Pertrochanteric; Sliding hip screw