The epidemiology and direct healthcare costs of aseptic nonunions in Germany – a descriptive report

Bone & Joint Research

article

Nike Walter¹  Katja Hierl¹  Christoph Brochhausen²  Volker Alt¹  Markus Rupp¹ 

[1] Department for Trauma Surgery, University Medical Center Regensburg;Institute of Pathology, University of Regensburg

关键词: Epidemiology;    Nonunion;    Direct healthcare costs;    nonunion of fracture;    epidemiology;    hip;    ankle;    Orthopedic Trauma;    orthopaedic and trauma surgery;    fracture-related infections;    surgical treatment;    femur fractures;    shoulder;   

DOI  :  10.1302/2046-3758.118.BJR-2021-0238.R3

学科分类：骨科学

来源: British Editorial Society Of Bone And Joint Surgery

【 摘 要 】

AimsThis observational cross-sectional study aimed to answer the following questions: 1) how has nonunion incidence developed from 2009 to 2019 in a nationwide cohort; 2) what is the age and sex distribution of nonunions for distinct anatomical nonunion localizations; and 3) how high were the costs for surgical nonunion treatment in a level 1 trauma centre in Germany?MethodsData consisting of annual International Classification of Diseases (ICD)-10 diagnosis codes from German medical institutions from 2009 to 2019, provided by the Federal Statistical Office of Germany (Destatis), were analyzed. Nonunion incidence was calculated for anatomical localization, sex, and age groups. Incidence rate ratios (IRRs) were determined and compared with a two-sample z-test. Diagnosis-related group (DRG)-reimbursement and length of hospital stay were retrospectively retrieved for each anatomical localization, considering 210 patients.ResultsIn 2019, a total of 11,840 nonunion cases (17.4/100,000 inhabitants) were treated. In comparison to 2018, the incidence of nonunion increased by 3% (IRR 1.03, 95% confidence interval (CI) 0.53 to 1.99, p = 0.935). The incidence was higher for male cases (IRR female/male: 0.79, 95% CI 0.76 to 0.82, p = 0.484). Most nonunions occurred at the pelvic and hip region (3.6/100,000 inhabitants, 95% CI 3.5 to 3.8), followed by the ankle and foot as well as the hand (2.9/100,000 inhabitants each). Mean estimated DRG reimbursement for in-hospital treatment of nonunions was highest for nonunions at the pelvic and hip region (€8,319 (SD 2,410), p < 0.001).ConclusionDespite attempts to improve fracture treatment in recent years, nonunions remain a problem for orthopaedic and trauma surgery, with a stable incidence throughout the last decade.

【 授权许可】

CC BY-NC