Factors Affecting Revenue From the Management of Pelvis and Acetabulum Fractures

Vallier, Heather A.; Cureton, Beth Ann; Patterson, Brendan M.

doi:10.1097/bot.0b013e318269b2c3

Cited by 18 publications

(8 citation statements)

References 42 publications

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“…Delay is also associated with longer hospital stays and ventilation times [ 1 , 2 , 10 , 14 , 17 , 18 , 24 ]. Ultimately, delay can generate increased costs of care and opportunity costs in terms of limited access for other patients to a given hospital system [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation

et al. 2015

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BackgroundOur group developed a protocol, entitled Early Appropriate Care (EAC), to determine timing of definitive fracture fixation based on presence and severity of metabolic acidosis. We hypothesized that utilization of EAC would result in fewer complications than a historical cohort and that EAC patients with definitive fixation within 36 h would have fewer complications than those treated at a later time.MethodsThree hundred thirty-five patients with mean age 39.2 years and mean Injury Severity Score (ISS) 26.9 and 380 fractures of the femur (n = 173), pelvic ring (n = 71), acetabulum (n = 57), and/or spine (n = 79) were prospectively evaluated. The EAC protocol recommended definitive fixation within 36 h if lactate <4.0 mmol/L, pH ≥7.25, or base excess (BE) ≥−5.5 mmol/L. Complications including infections, sepsis, DVT, organ failure, pneumonia, acute respiratory distress syndrome (ARDS), and pulmonary embolism (PE) were identified and compared for early and delayed patients and with a historical cohort.ResultsAll 335 patients achieved the desired level of resuscitation within 36 h of injury. Two hundred sixty-nine (80 %) were treated within 36 h, and 66 had protocol violations, treated on a delayed basis, due to surgeon choice in 71 %. Complications occurred in 16.3 % of patients fixed within 36 h and in 33.3 % of delayed patients (p = 0.0009). Hospital and ICU stays were shorter in the early group: 9.5 versus 17.3 days and 4.4 versus 11.6 days, respectively, both p < 0.0001. This group of patients when compared with a historical cohort of 1443 similar patients with 1745 fractures had fewer complications (16.3 versus 22.1 %, p = 0.017) and shorter length of stay (LOS) (p = 0.018).ConclusionsOur EAC protocol recommends definitive fixation within 36 h in resuscitated patients. Early fixation was associated with fewer complications and shorter LOS. The EAC recommendations are safe and effective for the majority of severely injured patients with mechanically unstable femur, pelvis, acetabular, or spine fractures requiring fixation.

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Section: Introductionmentioning

confidence: 99%

Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation

et al. 2015

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“…In this study, we retrospectively collected nearly three years of 254 patients with pelvic fractures were admitted in our hospital orthopedics, among them, 24 cases of pelvic fractures combination with humerus fracture, for most of all a single combined injury, and after the single factor analysis respectively, statistically signi cant only the pelvic fractures combination of humerus fracture. This discovery has not been mentioned in previous literature reports [1,2,[4][5][6][7][8][9][10][12][13][14][15][16][17][18][19][20][21][22][23]. The results of counting the causes of injuries show that there are 115 cases of car accidents, 79 cases of falls, 48 cases of high falls and 12 cases of crush injuries.…”

Section: Discussionmentioning

confidence: 72%

Risk factors of pelvic fracture combined with humeral fracture: A retrospective study

Chen

Zhang

et al. 2022

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Background: Pelvic fractures are often associated with other injuries, and in our study, pelvic fractures associated with humeral fractures were the most common. We pooled patient data to analyze the independent risk factors for pelvic fractures associated with humeral fractures. Methods: A retrospective study was conducted on the clinical data of 254 patients with pelvic fractures admitted to the Department of Orthopedics of Chengdu Fifth People’s Hospital, from August 2017 to August 2021. Independent sample T test found that pelvic fractures combined with humeral fractures were statistically significant. The main outcome indicators of pelvic fracture combined with humeral fracture were as follows: Tile classification of pelvic fractures, number of humeral fractures and Injury Severity Scale (ISS); Secondary outcome indicators: gender, age, body mass index (BMI), cause of injury, underlying diseases, etc. Single factor analysis was performed to screen risk factors for each indicator, and logistic analysis was used to determine independent risk factors for indicators with P < 0.05. Results: Of the 254 patients with pelvic fractures, 24 (9.45%) were associated with humeral fractures, much higher than other single injuries, and only pelvic fractures associated with humeral fractures were statistically significant (P=0.014). Pelvic fractures without concomitant humeral fractures (n=230) and pelvic fractures with concomitant humeral fractures (n=24) were associated with age (P=0.006; 95% CI = 0.087-0.665; OR=10.258), ISS score (P=0.002; 95% CI = 1.839-4.445; OR=8.721), Tile scores (P=0.01; 95% CI = 22.554-87.419; OR=22.736), but there was no statistical significance in gender (P=1.03), BMI (P=0.437) and injury cause (P=3.04). Conclusion: The combination of pelvic fracture and humerus fracture was statistically significant, and age > 60 years old, pelvic fracture Tile B2 classification above and high ISS were the independent risk factors for humerus fracture in pelvic fracture. Therefore, in clinical work, when clinicians treat patients with pelvic fractures aged > 60 years old, Tile B2 type above classification of pelvic fractures and high ISS, they should be highly vigilant about whether the humerus fractures are accompanied.

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Section: Discussionmentioning

confidence: 81%

Risk factors of pelvic fracture combined with humeral fracture: A retrospective study

Chen

Zhang

et al. 2022

Preprint

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Background Pelvic fractures are often associated with other injuries, and in our study, pelvic fractures associated with humeral fractures were the most common. We pooled patient data to analyze the independent risk factors for pelvic fractures associated with humeral fractures. Methods A retrospective study was conducted on the clinical data of 254 patients with pelvic fractures admitted to the Department of Orthopedics of Chengdu Fifth People’s Hospital, from August 2017 to August 2021. Independent sample T test found that pelvic fractures combined with humeral fractures were statistically significant. The main outcome indicators of pelvic fracture combined with humeral fracture were as follows: Tile classification of pelvic fractures, number of humeral fractures and Injury Severity Scale (ISS); Secondary outcome indicators: gender, age, body mass index (BMI), cause of injury, underlying diseases, etc. Single factor analysis was performed to screen risk factors for each indicator, and logistic analysis was used to determine independent risk factors for indicators with P < 0.05. Results Of the 254 patients with pelvic fractures, 24 (9.45%) were associated with humeral fractures, much higher than other single injuries, and only pelvic fractures associated with humeral fractures were statistically significant (P = 0.014). Pelvic fractures without concomitant humeral fractures (n = 230) and pelvic fractures with concomitant humeral fractures (n = 24) were associated with age (P = 0.006; 95% CI = 0.087–0.665; OR = 10.258), ISS score (P = 0.002; 95% CI = 1.839–4.445; OR = 8.721), Tile scores (P = 0.01; 95% CI = 22.554–87.419; OR = 22.736), but there was no statistical significance in gender (P = 1.03), BMI (P = 0.437) and injury cause (P = 3.04). Conclusion The combination of pelvic fracture and humerus fracture was statistically significant, and age > 60 years old, pelvic fracture Tile B2 classification above and high ISS were the independent risk factors for humerus fracture in pelvic fracture. Therefore, in clinical work, when clinicians treat patients with pelvic fractures aged > 60 years old, Tile B2 type above classification of pelvic fractures and high ISS, they should be highly vigilant about whether the humerus fractures are accompanied.

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Factors Affecting Revenue From the Management of Pelvis and Acetabulum Fractures

Abstract: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 18 publications

References 42 publications

Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation

Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation

Risk factors of pelvic fracture combined with humeral fracture: A retrospective study

Risk factors of pelvic fracture combined with humeral fracture: A retrospective study

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