title: Direct and indirect costs of surgically treated pelvic fractures.
abstract: BACKGROUND
  Pelvic fractures requiring surgical fixation are rare injuries but present a great societal impact in terms of disability, as well as economic resources. In the literature, there is no description of these costs. Main aim of this study is to describe the direct and indirect costs of these fractures. Secondary aims were to test if the type of fracture (pelvic ring injury or acetabular fracture) influences these costs (hospitalization, consultation, medication, physiotherapy sessions, job absenteeism).
  
  
  METHODS
  We performed a retrospective study on patients with surgically treated acetabular fractures or pelvic ring injuries. Medical records were reviewed in terms of demographic data, follow-up, diagnosis (according to Letournel and Tile classifications for acetabular and pelvic fractures, respectively) and type of surgical treatment. Patients were interviewed about hospitalization length, consultations after discharge, medications, physiotherapy sessions and absenteeism.
  
  
  RESULTS
  The study comprised 203 patients, with a mean age of 49.1 ± 15.6 years, who had undergone surgery for an acetabular fracture or pelvic ring injury. The median treatment costs were 29.425 Euros per patient. Sixty percent of the total costs were attributed to health-related work absence. Median costs (in Euros) were 2.767 for hospitalization from trauma to definitive surgery, 4.530 for surgery, 3.018 for hospitalization in the surgical unit, 1.693 for hospitalization in the rehabilitation unit, 1.920 for physiotherapy after discharge and 402 for consultations after discharge. Total costs for treating pelvic ring injuries were higher than for acetabular fractures, mainly due to the significant higher costs of pelvic injuries regarding hospitalization from trauma to definitive surgery (p < 0.001) and hospitalization in the surgical unit (p = 0.008).
  
  
  CONCLUSIONS
  Pelvic fractures are associated with both high direct costs and substantial productivity loss.
authors.affiliation: Medical School, University of Turin, Turin, Italy. ale_aprato@hotmail.com.
authors.forename: Alessandro
authors.identifier: http://orcid.org/0000-0002-2514-4719
authors.initials: A
authors.lastname: Aprato
authors.affiliation: Clinical Investigation and Documentation (C.I.D.) Department, AO Foundation, Dübendorf, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Joeris
authors.affiliation: Medical School, University of Turin, Turin, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Tosto
authors.affiliation: Clinical Investigation and Documentation (C.I.D.) Department, AO Foundation, Dübendorf, Switzerland.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Kalampoki
authors.affiliation: Medical School, University of Turin, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Stucchi
authors.affiliation: Medical School, University of Turin, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Massè
mesh_terms: D000041:Absenteeism; D000077:Acetabulum / Q000293:injuries / Q000601:surgery; D000328:Adult; D003365:Costs and Cost Analysis; D016527:Drug Costs; D005260:Female; D005592:Fracture Fixation / Q000191:economics*; D050723:Fractures, Bone / Q000191:economics / Q000601:surgery*; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010384:Pelvic Bones / Q000293:injuries*; D026741:Physical Therapy Modalities / Q000191:economics; D012017:Referral and Consultation / Q000191:economics; D012189:Retrospective Studies; D018582:Sick Leave / Q000191:economics*
keywords: Acetabular fracture; Cost analysis; Morbidity; Pelvic ring injuries; Work productivity