title: Open lower limb fractures in Major Trauma Centers - A loss leader?
abstract: OBJECTIVE
  Open lower limb fractures are resource intensive injuries. Regardless of the financing model, the cost of treatment is an important consideration for any healthcare provider.
  
  
  METHODS
  Open lower limb fractures treated at our centre were identified over a six-month period. Isolated open femur or tibia fractures were included as well as cases with multiple fractures. Direct inpatient care costs were calculated and income was reviewed for each case according to 'Healthcare Resource Group' (HRG) cost codes.
  
  
  RESULTS
  A total of 41 open lower limb fractures (32 patients) were identified. There were isolated open fractures in twenty-five and multiple lower limb open fractures in seven patients. Twenty-three patients (72%) were male and nine were female (28%) with an average age of 40 years (range 10-89 years). The fractures were classified according to Gustilo and Anderson (GA) and divided into two main groups; there were 13 mild and 28 severe open fractures. The median direct cost of inpatient treatment for open lower limb fractures was £19,189 per patient. There was a net gain of £6,288 per fracture in the mild group and a loss of £7,582 in the severe group. The total deficit was £149,545 over the six-month period for this cohort of 41 fractures.
  
  
  CONCLUSIONS
  Open lower limb fractures are expensive to treat at a cost of approximately £19,200 per patient and associated with a significant loss of income in our MTC. Cost codes should reflect the complex and more expensive treatment of these patients to avoid the inadvertent financial 'penalties' of treating such patients. This study is the first to calculate the direct inpatient treatment costs of open lower limb fractures in a major trauma centre. It highlights the need for cost saving strategies and for appropriate remuneration in MTCs.
authors.affiliation: Addenbrooke's Hospital, Hills Road, Cambridge, UK. Electronic address: elizabethkhadijatissingh@gmail.com.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Tissingh
authors.affiliation: Addenbrooke's Hospital, Hills Road, Cambridge, UK.
authors.forename: Arman
authors.initials: A
authors.lastname: Memarzadeh
authors.affiliation: Addenbrooke's Hospital, Hills Road, Cambridge, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Queally
authors.affiliation: Addenbrooke's Hospital, Hills Road, Cambridge, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Hull
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005592:Fracture Fixation / Q000191:economics*; D005597:Fractures, Open / Q000191:economics* / Q000534:rehabilitation / Q000601:surgery; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D059408:Pain Management / Q000191:economics; D026741:Physical Therapy Modalities / Q000191:economics; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics; D013978:Tibial Fractures / Q000191:economics* / Q000534:rehabilitation / Q000601:surgery; D014193:Trauma Centers / Q000191:economics*; D006113:United Kingdom; D055815:Young Adult
keywords: Femur; Open fracture; Tibia; Trauma