OBJECTIVES : This study evaluated the impact of infections on healthcare resource use and direct costs in England for patients undergoing intramedullary nailing (IMN) for tibial shaft fractures (TSF).

METHODS : A retrospective cohort design using the Clinical Practice Research Datalink-Hospital Episode Statistics linkage datasets from England were used. Patients ≥18 years hospitalized for IMN treatment (index) for TSF between 2003 and 2017 were identified and followed for two years post discharge from index hospitalization. Healthcare resource utilization in terms of length of stay (LOS), readmissions, reoperations and all-cause direct costs were compared between the patients with and without infections over two years follow-up. Generalized linear regressions were built to adjust for the patient demographic and clinical characteristics and the method of least squares means was used to report the adjusted results by infection status.

RESULTS : A total of 588 patients (mean age= 41.33 years and females= 27.7 %) were included in the analysis. The rates of infection increased from 9.2% in three months to 11.7% in one year and reached 13.4% over the two years follow-up. The regression adjusted results showed that the patients with infection had statistically significantly higher LOS (24.6 days vs 11.3 days), readmissions (77.6% vs 51.4%) and reoperations (49.0% vs 31.2%) (All p<0.05) than the patients without infections. The adjusted mean all-cause total costs were statistically significantly higher among patients with infection than without (£16,626 vs £9,439, p<0.0001) with inpatients costs as the key driver (£14,898 vs £8,447, p<0.0001) for the total costs.

CONCLUSIONS : This real-world study in England found that infection following IMN for TSF is a substantial healthcare burden over two years post-surgery, leading to significantly increased hospital LOS, need for hospital readmission and reoperation. Patients that developed infection had 76% higher total direct costs than patients without infection.