OBJECTIVES

: Comminuted tibial fractures are associated with high risks of complications and may require multiple surgeries. This study evaluated typical patient costs and payments over a 2-year pathway following comminuted Gustilo-Anderson (GA) Type III fractures.

METHODS

: A retrospective database analysis was conducted in the IBM® MarketScan® Commercial and Medicaid® Databases (IMD) and the Premier Hospital Database (PHD). Patients with Type III comminuted tibial fractures or open tibial fractures requiring saucerization based on diagnostic and procedure codes within inpatient visits were identified. Patients with amputation of lower limb at time of index were excluded from the analysis. Costs and payments at index (PHD) and for up to 2-years post-index (IMD) were analyzed. Mean, median and standard deviation (SD) for costs were evaluated after log transform and removal of outliers using inflation-adjusted costs to US$ 2018 consumer-price index.

RESULTS

: From the PHD database, 1,500 patients were identified. Hospital cost at index averaged US$ 43.8K (standard deviation (SD): US$ 26.7). The hospital cost per patient was as follows: patients with two admissions (index plus one) incurred an average cost of US$ 95.4K (SD US$ 104K), patients with three admissions: US$ 119K (SD US$ 150K) and ³ 4 admissions: US$ 192K (US$ 263K). Over the 2-year post-index, 71% patients had at least 1 additional inpatient admission, with 11.1% requiring 4 or more admissions. Total payments from commercial insurance averaged US$ 204K (SD: 123.2K - median payment: US$ 186K). For Medicaid patients, only 19.6% patients had reported payments over the 2-year period. When payments were shown, total payments averaged US$73.6 (SD: 130.9K - median payment: US$ 29.8K), far below the average hospital cost per patient, estimated at US$137 (SD 211K).

CONCLUSIONS

: Comminuted Tibial GA Type III Fractures represent significant healthcare challenges as patients require multiple admissions and high costs that can exceed average reimbursements.