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

Abstract

Aims This 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? Methods Data 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. Results In 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). Conclusion Despite 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. Cite this article: Bone Joint Res 2022;11(8):541–547.

Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment

“…The remaining patients could not afford the subsequent treatment due to the high economic burden. 22 A cost of $17,000 to $150,000 per patient has been reported, 23 , 24 which is much worse in countries with limited resources.…”

Epidemiology and treatment of proximal femoral fractures in the elderly U.S. population

“…Incidence rate ratios (IRR) with the corresponding 95% confidence interval (CI) were calculated by dividing the incidence in 2019 by the incidence of the preceding year. Incidence rates were compared using the two-sample z-test 8 .…”

Bone Healing Gone Wrong: Pathological Fracture Healing and Non-Unions—Overview of Basic and Clinical Aspects and Systematic Review of Risk Factors

“…Non-unions appear rarely, but represent one of the most severe complications in trauma and orthopedic surgery. Their frequency depends on the applied definition and varies between 2-10% of all fractures, but may reach 50% in open tibial fractures [7,15,16]. Delayed healing (no bony healing after four months) [17] affects an estimated 600,000 fractures per year, and around 100,000 fractures in the US display non-union [12,18].…”

“…The approximate costs for treatment of long-bone non-unions are estimated to be at least USD 11,333 in the US [12], USD 17,000-18,000 in the UK [24], USD 9641 in Australia [25] and between USD 2900 and USD 6300 in Germany [16]. In the USA, a tibial shaft non-union was USD 13,870 more expensive than the regular healing process [26], while overall costs of delayed fracture healing in the USA are estimated at around USD 14.6 million annually [15].…”