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Kay HF, Buss JL, Keller MR, Olsen MA, Brogan DM, Dy CJ. Catastrophic Health Care Expenditure Following Brachial Plexus Injury. J Hand Surg Am 2023; 48:354-360. [PMID: 36725391 PMCID: PMC10079640 DOI: 10.1016/j.jhsa.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/25/2022] [Accepted: 12/08/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Brachial plexus injuries (BPIs) are devastating to patients not only functionally but also financially. Like patients experiencing other traumatic injuries and unexpected medical events, patients with BPIs are at risk of catastrophic health expenditure (CHE) in which out-of-pocket health spending exceeds 40% of postsubsistence income (income remaining after food and housing expenses). The individual financial strain after BPIs has not been previously quantified. The purpose of this study was to assess the proportion of patients with BPIs who experience risk of CHE after reconstructive surgery. METHODS Administrative databases were used from 8 states to identify patients who underwent surgery for BPIs. Demographics including age, sex, race, and insurance payer type were obtained. Inpatient billing records were used to determine the total surgical and inpatient facility costs within 90 days after the initial surgery. Due to data constraints, further analysis was only conducted for privately-insured patients. The proportion of patients with BPIs at risk of CHE was recorded. Predictors of CHE risk were determined from a multivariable regression analysis. RESULTS Among 681 privately-insured patients undergoing surgery for BPIs, nearly one-third (216 [32%]) were at risk of CHE. Black race and patients aged between 25 and 39 years were significant risk factors associated with CHE. Sex and the number of comorbidities were not associated with risk of CHE. CONCLUSIONS Nearly one-third of privately-insured patients met the threshold for being at risk of CHE after BPI surgery. CLINICAL RELEVANCE Identifying those patients at risk of CHE can inform strategies to minimize long-term financial distress after BPIs, including detailed counseling regarding anticipated health care expenditures and efforts to optimize access to appropriate insurance policies for patients with BPIs.
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Affiliation(s)
- Harrison F Kay
- Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, MO
| | - Joanna L Buss
- Center for Administrative Data Research, Washington University in St Louis School of Medicine, St Louis, MO
| | - Matthew R Keller
- Center for Administrative Data Research, Washington University in St Louis School of Medicine, St Louis, MO
| | - Margaret A Olsen
- Center for Administrative Data Research, Washington University in St Louis School of Medicine, St Louis, MO
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, MO
| | - Christopher J Dy
- Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, St Louis, MO.
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Abstract
Clenched fist injury is associated with a high risk of infectious complications and is commonly managed with formal irrigation and debridement in the operating theatre. The purpose of this study was to determine outcomes associated with irrigation and debridement of clenched fist injuries under local anaesthesia using field sterility outside the operative theatre. In this single centre study, 232 patients were identified with clenched fist injury and 210 were treated with a standard protocol beginning with administration of intravenous antibiotics and then irrigation and debridement at the bedside. Primary outcome measures were the need for repeat debridement and complications. Secondary outcome measures included factors associated with the need for repeat debridement. Fifteen of the 210 patients (7%) required repeat debridement. Patients with cultures positive for gram-negative organisms had a significantly increased risk of repeat debridement. Irrigation and debridement under local anaesthesia using field sterility results in an acceptably low risk of complications or need for repeat debridement.Level of evidence: IV.
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Affiliation(s)
- Harrison F Kay
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Hyunwoo P Kang
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Robert Fisch
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Milan Stevanovic
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Luke T Nicholson
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
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Azad A, Kang HP, Alluri RK, Vakhshori V, Kay HF, Ghiassi A. Epidemiological and Treatment Trends of Distal Radius Fractures across Multiple Age Groups. J Wrist Surg 2019; 8:305-311. [PMID: 31404224 PMCID: PMC6685779 DOI: 10.1055/s-0039-1685205] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/27/2019] [Indexed: 02/01/2023]
Abstract
Background The purpose of this study is to assess the epidemiology, population-specific treatment trends, and complications of distal radius fractures in the United States. Methods The PearlDiver database (Humana [2007-2014], Medicare [2005-2014]) was used to access US inpatient and outpatient data for all patients who had undergone operative and nonoperative treatment for a distal radius fracture in the United States. Epidemiologic analysis was performed followed by age-based stratification, to assess prevalence, treatment trends, and rates of complications. Results A total of 1,124,060 distal radius treatment claims were captured. The incidence of distal radius fractures follows a bimodal distribution with distinct peaks in the pediatric and elderly population. Fractures in the pediatric population occurred predominately in males, whereas fractures in the elderly population occurred more frequently in females. The most commonly used modality of treatment was nonoperative; however, the use of internal fixation increased significantly during the study period, from 8.75 to 20.02%, with a corresponding decrease in percutaneous fixation. The overall complication rate was 8.3%, with mechanical symptoms most frequently reported. Conclusions The last decade has seen a significant increase in the use of internal fixation as treatment modality for distal radius fractures. The impetus for this change is likely multifactorial and partly related to recent innovations including volar locking plates and an increasingly active elderly population. The implicated financial cost must be weighed against the productivity cost of maintaining independent living to determine the true burden to the healthcare system.
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Affiliation(s)
- Ali Azad
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, California
| | - H. Paco Kang
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, California
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, California
| | - Venus Vakhshori
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, California
| | - Harrison F. Kay
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, California
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center at the University of Southern California, Los Angeles, California
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Vasquez RA, Chotai S, Freeman TH, Kay HF, Cheng JS, McGirt MJ, Devin CJ. Impact of Discharge Disposition on 30-Day Readmissions Following Elective Spine Surgery. Neurosurgery 2017; 81:772-778. [PMID: 28605552 DOI: 10.1093/neuros/nyx114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 05/31/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Readmissions are a significant economic burden on the health care system and increasingly being utilized as a metric of quality. Patients discharged to home vs an inpatient facility have different characteristics, which might influence the readmissions following spine surgery. OBJECTIVE To determine the effect of discharge disposition on readmission rates and causes of readmission after spine surgery. METHODS Patients enrolled in a prospective registry and undergoing elective spine surgery were analyzed. Readmissions (30 d), demographic, clinical variables, and baseline patient-reported outcomes were recorded. Patients were dichotomized as discharged home vs inpatient facility. RESULTS Of total 1631 patients, 1444 (89%) patients were discharged home and 187 (11%) discharged to an inpatient facility. Sixty-five (4%) patients were readmitted at 30 d. There was no significant difference in readmissions between patients discharged to a facility 10 (5%) vs home 55 (4%; P = .210). In a multivariable analysis, adjusting for all the comorbidities, the discharge destination was not associated with readmission within 30 d. The medical complications (80%) were the most common cause of readmission in those discharged to a facility. Patients discharged home had significantly higher readmissions related to surgical wound issues (67%; P = .034). CONCLUSION Despite the older age and higher comorbidities in patients discharged to an inpatient facility, the proportion of readmissions was comparable to those discharged home. Patients discharged home had a higher proportion of readmissions related to surgical wound complications and those discharged to facility had higher readmissions associated with medical complications. Understanding causes of readmission based on discharge destination may allow targeted intervention to reduce the readmission rates following spine surgery.
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Affiliation(s)
- Raul A Vasquez
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky
| | - Silky Chotai
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas H Freeman
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harrison F Kay
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph S Cheng
- Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Clinton J Devin
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Chotai S, Parker SL, Sielatycki JA, Sivaganesan A, Kay HF, Wick JB, McGirt MJ, Devin CJ. Erratum to: Impact of old age on patient-report outcomes and cost utility for anterior cervical discectomy and fusion surgery for degenerative spine disease. Eur Spine J 2017; 26:1324. [PMID: 28213693 DOI: 10.1007/s00586-017-4991-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Silky Chotai
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Parker
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alex Sielatycki
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ahilan Sivaganesan
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harrison F Kay
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph B Wick
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | - Clinton J Devin
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Chotai S, Parker SL, Sielatycki JA, Sivaganesan A, Kay HF, Wick JB, McGirt MJ, Devin CJ. Impact of old age on patient-report outcomes and cost utility for anterior cervical discectomy and fusion surgery for degenerative spine disease. Eur Spine J 2016; 26:1236-1245. [PMID: 27885477 DOI: 10.1007/s00586-016-4835-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 09/21/2016] [Accepted: 10/20/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE With growing older population and increasing rates of cervical spinal surgery, it is vital to understand the value of cervical surgery in this population. We set forth to determine the cost utility following anterior cervical decompression and fusion (ACDF) for degenerative disease in older patients. METHODS Patients undergoing ACDF for degenerative diseases were enrolled into prospective longitudinal registry. Patient-reported outcomes (PROs) were recorded at baseline, 1-year, and 2-year postoperatively. Two-year medical resource utilization, missed work, and health-state values [quality-adjusted life years (QALYs)] were assessed to compute cost per QALY gained. Patients were dichotomized based on age: <65 years (younger) and ≥65 years (older) to compare the cost utility in these age groups. RESULTS Total 218 (87%) younger patients and 33 (13%) older patients who underwent ACDF were analyzed. Both the groups demonstrated a significant improvement in PROs 2-year following surgery. The older patients had a lower mean cumulative gain in QALYs compared to younger patients at 1 year (0.141 vs. 0.28, P = 0.05) and 2 years (0.211 vs. 0.424, P = 0.04). There was no significant difference in the mean total 2-year cost between older [$21,041 (95% CI $18,466-$23,616)] and younger [$22,669 (95% CI $$21,259-$24,079)] patients (P = 0.27). Two-year cost per QALY gained in older vs. younger patients was ($99,720/QALYs gained vs. ($53,464/QALYs gained, P = 0.68). CONCLUSION ACDF surgery provided a significant gain in health-state utility in older patients with degenerative cervical pathology, with a mean cumulative 2-year cost per QALY gained of $99,720/QALY. While older patients have a slightly higher cost utility compared to their younger counterparts, surgery in the older cohort does provide a significant improvement in pain, disability, and quality-of-life outcomes.
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Affiliation(s)
- Silky Chotai
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Parker
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Alex Sielatycki
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ahilan Sivaganesan
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harrison F Kay
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joseph B Wick
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | - Clinton J Devin
- Department of Orthopedics Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA. .,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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An TJ, Thakore RV, Greenberg SE, Sathiyakumar V, Kay HF, Gerasimopoulos M, Obremskey WT, Sethi MK. Locking Versus Nonlocking Implants in Isolated Lower Extremity Fractures: Analysis of Cost and Complications. J Surg Orthop Adv 2016; 25:49-53. [PMID: 27082888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to investigate operative costs and postoperative complication rates in relation to utilization of locking versus nonlocking implants in isolated, lower limb fractures. Seventy-seven patients underwent plate fixation of isolated bicondylar tibial plateau, bimalleolar ankle, and trimalleolar ankle fractures at a large tertiary care center. Fixation with locking versus nonlocking implants was compared to incidence of postsurgical complications. Costs of these implants were directly compared. No significant correlation was found between locking versus nonlocking implants and incidence of complications. However, the cost of fixation with locking implants was significantly greater than nonlocking for all fractures. Utilization of more costly locking implants was not associated with reduced postoperative complications compared with nonlocking implants. More attention must be dedicated toward maximizing cost efficiency, since uniform usage of nonlocking implants has the potential to reduce surgical costs without compromising patient outcomes in isolated lower extremity fractures.
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Affiliation(s)
- Thomas J An
- The Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, Tennessee
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Snoddy MC, An TJ, Hooe BS, Kay HF, Lee DH, Pappas ND. Incidence and reasons for hardware removal following operative fixation of distal radius fractures. J Hand Surg Am 2015; 40:505-7. [PMID: 25618844 DOI: 10.1016/j.jhsa.2014.11.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 11/14/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the incidence and reasons for hardware removal after operative fixation of distal radius fractures. METHODS We retrospectively reviewed 33 patients who underwent removal of a volar distal radius plate from 2007 to 2013. We recorded the primary reason for plate removal, patient sex, body mass index, AO fracture type, and plate manufacturer. The total number of both distal radius plating procedures and implant removals was analyzed. RESULTS Of the 33 patients who underwent implant removal, the most common reasons for removal were pain (30%), tenosynovitis (27%), malunion (24%), infection (12%), nonunion (6%), and tendon rupture (3%). The most common AO fracture types requiring plate removal were A2, C2, and C3 (7 each). A total of 517 distal radius fractures received plate fixation at our institution from 2007 to 2009, a number that rose to 610 from 2010 to 2012. The number of distal radius plate removals over that same time was relatively constant at 17 and 16, respectively. CONCLUSIONS We advise continued review of reasons for implant removal to limit future hardware complications related to volar plating of distal radius fractures. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Mark C Snoddy
- Vanderbilt Orthopaedic Institute, Vanderbilt University, Nashville, TN; Louisiana State University School of Medicine, New Orleans, LA.
| | - Thomas J An
- Vanderbilt Orthopaedic Institute, Vanderbilt University, Nashville, TN; Louisiana State University School of Medicine, New Orleans, LA
| | - Benjamin S Hooe
- Vanderbilt Orthopaedic Institute, Vanderbilt University, Nashville, TN; Louisiana State University School of Medicine, New Orleans, LA
| | - Harrison F Kay
- Vanderbilt Orthopaedic Institute, Vanderbilt University, Nashville, TN; Louisiana State University School of Medicine, New Orleans, LA
| | - Donald H Lee
- Vanderbilt Orthopaedic Institute, Vanderbilt University, Nashville, TN; Louisiana State University School of Medicine, New Orleans, LA
| | - Nick D Pappas
- Vanderbilt Orthopaedic Institute, Vanderbilt University, Nashville, TN; Louisiana State University School of Medicine, New Orleans, LA
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Bible JE, Kadakia RJ, Kay HF, Zhang CE, Casimir GE, Devin CJ. How often are interfacility transfers of spine injury patients truly necessary? Spine J 2014; 14:2877-84. [PMID: 24743061 DOI: 10.1016/j.spinee.2014.01.065] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/13/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Traumatic spine injuries are often transferred to regional tertiary trauma centers from outside hospitals (OSHs) and subsequently discharged from the trauma center's emergency department (ED) suggesting secondary overtriage of such injuries. PURPOSE The aim of the study was to investigate the definitive treatment and disposition of traumatic spine injuries transferred from OSH, particularly those without other trauma injuries or neurologic symptoms. STUDY DESIGN This was a retrospective study. PATIENT SAMPLE Adult patients presenting to a single Level 1 trauma center with spine injuries were included. OUTCOME MEASURES The outcome measures considered in the study were appropriateness of transfer, treatment, and cost. METHODS Four thousand five-hundred consecutive adult patients presenting to a single Level 1 trauma center with spine injuries (isolated or polytrauma) were reviewed. This consisted of 1,427 patients (32%) transferred from an OSH ED. All OSH, emergency medical services, and receiving institution (RI) patient records and imaging were reviewed. RESULTS Patients who were neurologically intact, nonpolytrauma, and without critical medical issues at the OSH (isolated intact spine transfers) comprised 29% of transfers. Helicopters transported 13% of these patients. The most frequent injuries were compression (26%), burst (17%), and transverse process (10%) fractures. Seventy-eight percent were discharged directly from the RI's ED. Similarly, 15% were not given any formal treatment, 13% had surgery, and 72% given orthosis treatment. The average cost for transportation and ED costs for those discharged from the RI ED were $1,863 and $12,895, respectively. Of the isolated intact spine transfers, 42% were considered to be inappropriate to warrant transfer. This was defined as those sent from an OSH with an orthopedic or neurosurgeon on staff and clearly stable injuries with minimal chance of progressing to instability. Isolated intact spine transfers whose OSH spine imaging was not considered unstable was 25% of transfers with a helicopter used to transport 14% of these patients. Eighty-seven percent were discharged from the ED, whereas only 3% went onto surgery. CONCLUSIONS This study is the first to investigate interfacility transfers with spine injuries and found high rate of secondary overtriage of neurologically intact patients with isolated spine injuries. Potential solutions include increasing spine coverage in community EDs, increasing direct communication between the OSH and the spine specialist at the tertiary center, and utilization of teleradiology.
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Affiliation(s)
- Jesse E Bible
- Vanderbilt Orthopaedic Institute, 1215 21st Ave. South, Medical Center East, S Tower, Suite 4200, Nashville, TN 37232, USA.
| | - Rishin J Kadakia
- Vanderbilt Orthopaedic Institute, 1215 21st Ave. South, Medical Center East, S Tower, Suite 4200, Nashville, TN 37232, USA
| | - Harrison F Kay
- Vanderbilt Orthopaedic Institute, 1215 21st Ave. South, Medical Center East, S Tower, Suite 4200, Nashville, TN 37232, USA
| | - Chi E Zhang
- Vanderbilt Orthopaedic Institute, 1215 21st Ave. South, Medical Center East, S Tower, Suite 4200, Nashville, TN 37232, USA
| | - Geoffrey E Casimir
- Vanderbilt Orthopaedic Institute, 1215 21st Ave. South, Medical Center East, S Tower, Suite 4200, Nashville, TN 37232, USA
| | - Clinton J Devin
- Vanderbilt Orthopaedic Institute, 1215 21st Ave. South, Medical Center East, S Tower, Suite 4200, Nashville, TN 37232, USA
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Mendenhall SK, Lee DS, Armaghani SJ, Bible JE, Shau D, Kay HF, Zhang C, McGirt MJ, Devin CJ. 141 Preoperative Narcotic Use is Associated With Worse Postoperative Self-Reported Outcomes in Patients Undergoing Spine Surgery. Neurosurgery 2014. [DOI: 10.1227/01.neu.0000452415.53452.ff] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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