title: The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study.
abstract: The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people placing greater demands on their prostheses, the number of peri-prosthetic fractures is increasing. We studied the economic impact this has on a large teaching hospital. All patients with peri-prosthetic femoral fracture in a 7.5 year period were identified. Radiographic and case note analysis was performed. Costings from the finance departments were obtained. 90 cases were identified, 58 female and 32 male, with a mean age of 76 (range: 38-91). 89 of the cases were managed surgically, 66% undergoing revision and 33% receiving open reduction and internal fixation. According to the Vancouver Classification, 3% were Type A, 79% Type B and 18% Type C. The mean length of stay was 43 days. The mean cost of management was £31,370 (range: £6885-£112,327). Patients with type C fractures had the highest mean length of stay at 53 days and mean cost of £33,417. Including rehabilitation costs, our study illustrated a mean cost of £31,370, roughly four times the current basic NHS tariff of £8552. Although implant costs are greater, treatment with revision where appropriate allows earlier weight bearing, reduced length of stay and lower overall cost.
authors.affiliation: Trauma and Orthopaedics, University Hospital Wales, Cardiff, United Kingdom. Electronic address: Andrew.jones@doctors.org.uk.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Jones
authors.affiliation: Trauma and Orthopaedics, University Hospital Wales, Cardiff, United Kingdom.
authors.forename: Tim
authors.initials: T
authors.lastname: Williams
authors.affiliation: Trauma and Orthopaedics, University Hospital Wales, Cardiff, United Kingdom.
authors.forename: Vishal
authors.initials: V
authors.lastname: Paringe
authors.affiliation: Trauma and Orthopaedics, University Hospital Wales, Cardiff, United Kingdom.
authors.forename: Simon P
authors.initials: SP
authors.lastname: White
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005593:Fracture Fixation, Internal / Q000191:economics*; D006302:Health Services Research; D006622:Hip Prosthesis / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D057068:Periprosthetic Fractures / Q000191:economics* / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000191:economics* / Q000601:surgery; D012086:Reoperation / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014852:Wales
keywords: Economic impact; Fracture; Hip replacement; Peri-prosthetic