OBJECTIVES : Tibia and fibula fractures are often successfully treated with open reduction internal fixation (ORIF) procedures. However, hardware removal may be required for patients with post-surgical complications. The purpose of this study was to evaluate the complications, healthcare resource utilization and costs associated with hardware removal within 1-year post-index ORIF.

METHODS : The IBM Marketscan Commercial and Medicare databases between 2010 and 2017 were used to design this retrospective observational cohort study. Participants were ≥18 years old, diagnosed with tibia or fibula fractures, and treated with ORIF (index) in an inpatient setting. A continuous enrollment between 6-month pre-index and 1-year post-discharge from index hospitalization was required for inclusion. Patients were divided into two groups based on post-surgical hardware removal identified over 1-year period after index discharge. Complication rates including infections and nonunion; healthcare resource utilization in terms of all-cause readmission and emergency visits; and all-cause costs of post-index discharge treatment were compared between patients with and without hardware removal.

RESULTS : A total of 23,888 patients with ORIF for tibia or fibula fractures were identified. The patients were mostly female (59.7%) with a mean (SD) age of 53.1 (16.6) years. Over the 1-year period, 17.7%% had hardware removed. Patients with hardware removal had statistically significantly higher rates of infection (27.7% % vs 5.9%), non-union (19.1% vs 5.4%), emergency visits (31.0% vs 24.7%) and readmission rates (32.2% vs 15.6%) (All p<0.0001). The mean (SD) all-cause costs post-index discharge was statistically significantly higher ($36,870 [$62,818] vs $17,133 [$38,428] among the patients with hardware removal as compared to those without (p<0.0001).

CONCLUSIONS : Complication rates and healthcare resource utilization were significantly higher in patients requiring hardware removal after ORIF for tibia or fibula fractures. All-cause costs among patients with hardware removal was 115% higher than that of patients without hardware removal.