Comment: Theca Primary Cost Drivers of Outpatient Distal Radius Fracture Fixation: A Cost-Minimalization Analysis of 15,379 Cases

Abstract

We read this article with interest and agree with Hresko et al 1 on the influence of patient characteristics and operative technique on the overall costs of internal fixation of distal radius fractures in adults, including postoperative admission within 30 days.However, Hresko et al 1 considered their medico-economic study on the aspect of decreasing expenses for the health system in general. We believe that it is also important to approach the medico-economic studies on the aspect of increasing revenues for health care institutions in general. For example, we have shown in a recent study that the management of distal radius fractures in adults on an outpatient basis was financially more valuable than conventional hospitalization. 2 Under these conditions, should we give priority to reducing expenditure for the health system at the risk of putting a strain on the budget of the health establishment in which we work? In our experience, the power of the hospital administration rather puts pressure on surgeons in favor of the hospital's economy and not in favor of the health system. Moreover, from an ethical point of view, should we prioritize the reduction of expenses for the health system in general or the quality and comfort of care for patients? The most telling example is indeed the type of anesthesia. Hresko et al 1 have shown that locoregional anesthesia is more expensive than general anesthesia. But, as they themselves say, the postoperative results are better under locoregional anesthesia than under general anesthesia. Should economic cost prevail over quality and comfort of care? We think not.We congratulate Hresko et al 1 for their very interesting article that shows the importance of medico-economic studies in the management of wrist fractures.