Abstract
Few studies have examined the socio-economic impact of complications requiring surgery following initial surgical management of proximal femoral fractures. Our hypothesis was that there would be a significant difference in the cost, mortality rate and ultimate discharge location in patients requiring further surgery after their index procedure for a proximal femoral fracture compared to a matched control group.
This was a retrospective matched cohort study of all proximal femoral fractures presenting to the John Radcliffe Hospital over a five year period. Data had been collected prospectively in a standard manner. The total cost of treatment for each patient was calculated by separating the treatment costs into its components. Mortality data was retrieved from the Office of National Statistics and data were analysed using SPSS statistics software, with a p value of less than 0.05 considered significant.
There were 2360 proximal femoral fractures in 2257 patients. Of this group, 144 (6.1%) required further surgical intervention due to a complication of the primary procedure. Mean age at time of fracture was 82.59 years; 81.6% women. Mean cost of treatment in those cases with complications was £18,731 compared to £8,575 for uncomplicated cases (p=0.00) with a mean length of stay of 62.8 days and 32.7 days respectively (p=0.00). Mortality probability of cases was significantly higher than the control group with a mean survival of 209 days versus 496 days for controls (p= 0.035) and patients with complications were statistically less likely to return to their own home (p< 0.01).
The socio-economic impact of complications following treatment of proximal femoral fractures is important in this current economic climate. Greater awareness and understanding are warranted. Recognition of potential risk factors for complications may allow earlier detection of potential cases and thereby reduce their number and in turn the socioeconomic cost.
