Abstract
Aims
Infective complications following implant related orthopaedic surgery or fracture related infection are associated with high costs and increased length of stay (LOS). However, the economic burden of disease before, during and after definitive osteomyelitis surgery is not well quantified. The Hospital Episode Statistics (HES) database captures all admissions, outpatient appointments and emergency department attendances at NHS hospitals in England. We identified all patients with a diagnostic code of osteomyelitis and quantified the tariff costs associated with the surgical treatment of osteomyelitis. We also collected all recorded healthcare events related to osteomyelitis for two years preceding the initial osteomyelitis treatment procedure, as well as for two years after the procedure. We compared average osteomyelitis treatment costs in England against a dedicated specialist multidisciplinary bone infection centre.
Methods
We interrogated the HES database for all patients given a diagnostic code of osteomyelitis (M86) between April 2013 and January 2017. We excluded all cases with a diagnosis of osteomyelitis and an index procedure of an amputation for diabetes or arterial disease. Of the remaining 104,622 patients there were 24,408 cases who had their index procedure for osteomyelitis in this time period. Of these we compared a subset of 575 cases treated in a specialist bone infection centre.
Results
Index procedure costs were lower in specialist centres compared to national average (£4100.09 vs. 4835.59) equating to a potential saving of £4.67 million per year if all cases were treated in similar specialist centres. Average LOS for the index procedure was lower in the specialist centre (12.4 days) compared to the national average (17.3 days). Assuming a bed cost of £500 per day, treating all patients in similar specialist centres could save £15.95 million per year. The post procedure costs were lower for specialist centre patients compared to national average, equating to a potential saving of £7.42 million per year. The average post procedural LOS in the national cohort was 2.44 days longer than the specialist centre, equating to an additional 15,508 bed days per year.
Conclusions
Although tariff costs do not reflect true costs this study demonstrates that osteomyelitis is a significant economic burden to the English health service. Treating infection in dedicated specialist multidisciplinary centres requires a lot of resources and costs a lot of money. However, treating infection outside this environment seems to cost more and results in longer inpatient stays and higher associated costs.
