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Exploring trends in admissions and treatment for ankle fractures: a longitudinal cohort study of routinely collected hospital data in England

BMC health services research, 2020-08, Vol.20 (1), p.811-811, Article 811 [Peer Reviewed Journal]

COPYRIGHT 2020 BioMed Central Ltd. ;2020. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;The Author(s) 2020 ;ISSN: 1472-6963 ;EISSN: 1472-6963 ;DOI: 10.1186/s12913-020-05682-9 ;PMID: 32867779

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Title:
Exploring trends in admissions and treatment for ankle fractures: a longitudinal cohort study of routinely collected hospital data in England
Author: Scott, Lauren J ; Jones, Tim ; Whitehouse, Michael R ; Robinson, Peter W ; Hollingworth, William
Subjects: Adolescent ; Adult ; Age groups ; Aged ; Aged, 80 and over ; Analysis ; Ankle ; Ankle fracture ; Ankle Fractures - economics ; Ankle Fractures - epidemiology ; Ankle Fractures - surgery ; Ankle injuries ; Ankle Joint - surgery ; Care and treatment ; Close-contact-casting ; Codes ; Cohort Studies ; Cost control ; Cost Savings ; Cost-Benefit Analysis ; England ; Extramedullary fixation ; Female ; Fracture Fixation, Internal - economics ; Fracture Fixation, Internal - methods ; Fracture Fixation, Internal - statistics & numerical data ; Fracture Fixation, Intramedullary - economics ; Fracture Fixation, Intramedullary - methods ; Fracture Fixation, Intramedullary - statistics & numerical data ; Fractures ; Hospital admission ; Hospital admission and discharge ; Hospital Costs - statistics & numerical data ; Hospitalization - economics ; Hospitals ; Humans ; Internal Fixators - economics ; Intramedullary fixation ; Longitudinal Studies ; Male ; Males ; Middle Aged ; Patient Admission - economics ; Patient Readmission - economics ; Patient Readmission - statistics & numerical data ; Patients ; Population ; Statistics ; Surgery ; Transplants & implants ; Trauma ; Trends ; Young Adult
Is Part Of: BMC health services research, 2020-08, Vol.20 (1), p.811-811, Article 811
Description: Evidence on the most effective and cost-effective management of ankle fractures is sparse but evolving. A recent large RCT in older patients with unstable fractures found that management with close-contact-casting was functionally equivalent and more cost-effective than internal fixation. We describe temporal and geographic variation in ankle fracture management and estimate the potential savings if close-contact-casting was used more often in older patients. Patients admitted to hospital in England between 2007/08 and 2016/17 with an ankle fracture were identified using routine hospital episode statistics. We tested whether the use of internal fixation, and the proportion of internal fixations using intramedullary implants, changed over time. We estimated the potential annual cost savings if patients aged 60+ years were treated with close-contact-casting rather than internal fixation, in line with emerging evidence. Over the 10-year period, there were 223,465 hospital admissions with a primary ankle fracture diagnosis. The incidence (per 100,000) of internal fixation was fairly consistent over time in younger (33.2 in 2007/08, 30.9 in 2016/17) and older (36.5 in 2007/08, 37.4 in 2016/17) patients. The proportion of internal fixations which used intramedullary implants increased in both age groups (17.0-19.5% < 60 years; 15.2-17.4% 60+ years). In 2016/17, the cost of inpatient hospital care for ankle fractures in England was over £63.1million. If 50% of older patients who had an internal fixation instead had close-contact-casting, we estimate that approximately £1.56million could have been saved. Despite emerging evidence that non-surgical and surgical management achieve equivalent functional outcomes in older patients, the rate of surgical fixation has remained relatively stable over the decade. The health service could achieve substantial savings if a higher proportion of older patients were treated with close-contact-casting, in line with recent evidence.
Publisher: England: BioMed Central Ltd
Language: English
Identifier: ISSN: 1472-6963
EISSN: 1472-6963
DOI: 10.1186/s12913-020-05682-9
PMID: 32867779
Source: Geneva Foundation Free Medical Journals at publisher websites
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Exploring trends in admissions and treatment for ankle fractures: a longitudinal cohort study of routinely collected hospital data in England

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