Implications of Thoracic Epidural Analgesia on Hospital Charges in Rib Fracture Patients.
Rib fractures are present in more than 150,000 patients admitted to US trauma centers each year. Those who fracture two or more ribs are typically treated with oral analgesic drugs and are discharged with few complications. The cost of this care generally reflects its brevity. When a patient fractures three or more ribs, there is an elevated risk of complication. In response, treatments are often broadened and their durations prolonged; this affects cost. While health, function, and survival have been widely explored, patient billing has not. Thus, we evaluated the financial implications of one mode of treatment for patients with rib fractures: thoracic epidural analgesia (TEA).



We retrospectively analyzed the registry of a level II trauma center. All patients who fractured one or more ribs (n = 1,344) were considered; 382 of those patients were not candidates for epidural placement and were eliminated from analyses. Epidural placement was determined by individual clinicians. We used multiple linear regressions to determine predictors of cost.



After eliminating patients who were not eligible to receive TEA, the average patient bill was $59,123 ($10,631 per day of treatment). The administration of TEA predicted a 25% reduction in total billing (99% CI = -$21,429.55- -$7,794.66) and a 24% reduction in per-day billing (99% CI = -$3,745.99- -$1,276.14).



Patients who received TEA were more severely injured and required longer treatments; controlling for these variables, the use of TEA associated with reductions in the cost of receiving care. From an administrative and insurance perspective, more frequent reliance on TEA may be indicated.
Department of Health, Exercise, and Sport Sciences, University of the Pacific, Stockton, California.
Courtney D
CD
Jensen
Sum Integral, Chicago, Illinois.
Jamie T
JT
Stark
St. Vincent Hospital, Indianapolis, Indiana.
Lewis E
LE
Jacobson
St. Vincent Hospital, Indianapolis, Indiana.
Jan M
JM
Powers
St. Vincent Hospital, Indianapolis, Indiana.
Kathy L
KL
Leslie
Department of Physical Therapy, University of Connecticut, Storrs, Connecticut, USA.
Jeffrey M
JM
Kinsella-Shaw
Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
Michael F
MF
Joseph
Department of Physical Therapy, University of Connecticut, Storrs, Connecticut, USA.|Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
Craig R
CR
Denegar
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000191:economics* / Q000379:methods; D000700:Analgesics / Q000191:economics / Q000627:therapeutic use; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D059408:Pain Management / Q000191:economics* / Q000379:methods; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications*; D013904:Thoracic Vertebrae; D055815:Young Adult
D000700:Analgesics
Analgesic; Anesthesiology; Epidural; Pain Management; Pain Medicine; Regional Pain; Thoracic; Trauma; Treatment Outcome