Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England

BMC Musculoskeletal Disorders

Mollie Vanderkarr¹  Charisse Sparks¹  Laura V. Gador²  Javier Quintana Plaza³  Abhishek S. Chitnis⁴  Chantal E. Holy⁴  Anandan Manoranjith⁵  Simone Wolf⁶  Simon M. Lambert⁷ 

[1]DePuy Synthes, Inc., West Chester, PA, USA

[2]Johnson and Johnson GmbH, Neuss, Germany

[3]Johnson and Johnson, Madrid, Spain

[4]Medical Devices Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA

[5]Mu Sigma, Bangalore, India

[6]Synthes GmbH, Zuchwil, Switzerland

[7]University College London Hospital, London, UK

关键词: Clavicle;    Fractures, Bone;    Cost of Illness;    United Kingdom;    Cohort Studies;    Postoperative Complications;    Reoperation;   

DOI  :  10.1186/s12891-022-05075-5

来源: Springer

【 摘 要 】

IntroductionThe clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database.MethodsCPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010–2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery.Results21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)—84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156).ConclusionsComplication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need.

【 授权许可】

CC BY