Aims. Describe a statistical and
This paper describes the methods applied to assess the cost-effectiveness of cemented versus uncemented hemiarthroplasty among hip fracture patients in the World Hip Trauma Evaluation Five (WHiTE5) trial. A within-trial cost-utility analysis (CUA) will be conducted at four months postinjury from a health system (National Health Service and personal social services) perspective. Resource use pertaining to healthcare utilization (i.e. inpatient care, physiotherapy, social care, and home adaptations), and utility measures (quality-adjusted life years) will be collected at one and four months (primary outcome endpoint) postinjury; only treatment of complications will be captured at 12 months. Sensitivity analysis will be conducted to assess the robustness of the results.Aim
Methods
Aims. The aim of this study was to perform the first population-based description of the epidemiological and health
Aims. This study aims to estimate
To estimate the clinical and
Aims. The aim of this study was to estimate the clinical and
With an ageing population and an increasing number of primary arthroplasties performed, the revision burden is predicted to increase. The aims of this study were to 1. Determine the revision burden in an academic hospital over a 11-year period; 2. identify the direct hospital cost associated with the delivery of revision service and 3. ascertain factors associated with increased cost. This is an IRB-approved, retrospective, single tertiary referral center, consecutive case series. Using the hospital data warehouse, all patients that underwent revision hip or knee arthroplasty surgery between 2008-2018 were identified. 1632 revisions were identified (1304 patients), consisting of 1061 hip and 571 knee revisions. The majority of revisions were performed for mechanical-related problems and aseptic loosening (n=903; 55.3%); followed by periprosthetic joint infection (n=553; 33.9%) and periprosthetic fractures (176; 10.8%). Cost and length of stay was determined for all patient. The direct in-hospital costs were converted to 2020 inflation-adjusted Canadian dollars. Several patients- (age; gender; HOMR- and ASA-scores; Hemoglobin level) and surgical- (indication for surgery; surgical site) factors were tested for possible associations. The number of revisions increased by 210% in the study period (2008 vs. 2018: 83 vs. 174). Revision indications changed over study period; with prevalence of fracture increasing by 460% (5 in 2008 vs. 23 in 2018) with an accompanying reduction in mechanical-related reasons, whilst revisions for infection remained constant. The mean annual cost over the entire study period was 3.9 MMCAD (range:2.4–5.1 MMCAD). The cost raised 150% over the study period from 2.4 MMCAD in 2008 to 3.6 MMCAD. Revisions for fractured had the greatest length of stay, the highest mean age, HOMR-score, ASA and cost associated with treatment compared to other revision indications (p < 0 .001). Patient factors associated with cost and length of stay included ASA- and HOMR-scores, Charlson-Comorbidity score and age. The revision burden increased 1.5-fold over the years and so has the direct cost of care delivery. The increased cost is primarily related to the prolonged hospital stay and increased surgical cost. For tertiary care units, these findings indicate a need to identify strategies on improving efficiencies whilst improving the quality of patient care (e.g. efficient ways of reducing acute hospital stay) and reducing the raise of the
Introduction. Cementless total knees were historically associated with early failure. These failures, likely associated with implant design, made cemented total knee arthroplasty (TKA) the “gold standard”. Manufacturers have introduced newer uncemented technologies that provide good initial stability and utilize a highly-porous substrates for bony in-growth. Outcome data on these implants has been limited. In addition, these implants typically have a price premium which makes them difficult to use in the setting of cost containment and in at risk 90-day bundles. Our purpose was to compare 90-day outcomes of a new uncemented implant with those of a comparable cemented implant from the same manufacturer. We hypothesized that the implants would have equivalent 90-day clinical and
Background. Total hip arthroplasty (THA) has become one of the most commonly performed elective procedures. Today, there are nearly 50 000 annual hospitalizations for hip replacement surgery in Canada. This number is projected to increase significantly with the aging population. Periprosthetic joint infection (PJI) is the 3rd leading cause of failure following THA and is reported to occur at an incidence of 1–3%. A two-stage revision THA is the current gold standard treatment and this has a tremendous
Introduction. Total knee and hip arthroplasty were the main arthroplasty surgery performed in Brazil. In Brazil, around 50% of arthroplasty surgeries are performed by the public health system, knowing as SUS . 1. SUS is the biggest public and universal health system in the world, attending 100% of the Brazilian population (220 million), with 2020's expected budget of US$ 31 billion . 2,3. . The National Institute of Clinical Excellence utilizes the QALY system (Quality adjustment year life)to calculate the best cost-benefit between medical interventions . 4. In compliance with the study, an operated person has a QALY index of £5000 while a non-operated person has an index of £7182. In March 2020, due to the COVID-19 pandemics, the Brazilian Health Ministry oriented for the postponing of elective surgery, to prioritize combating the virus . 5. This postponing, it was important but will cause an impact in the economy at the public health system from Brazil this year and in the next years. Therefore, this study aims to present the
Introduction. Management of complex fractures poses a significant challenge. Evolving research and changes to national guidelines suggest better outcomes are achieved by transfer to specialist centres. The development of Major Trauma Networks was accompanied by relevant financial arrangements. These do not apply to patients with closed fractures referred for specialist treatment by similar pathways. Despite a surge in cases transferred for care, there is little information available regarding the financial impact on receiving institutions. Materials & Methods. This retrospective study examines data from a Level 1 trauma centre. Patients were identified from our electronic referral system, used for all referrals. Transferred adult patients, undergoing definitive treatment of acute isolated closed tibial fractures, were included for a 2-year period. Data was collected using our clinical and Patient Level Information and Costing (PLICS) systems including coding, demographics, treatment, length of stay (LOS), total operative time, number of operations, direct healthcare costs, and NHS reimbursements. Results. 104 patients were identified, 23 patients were treated by internal fixation and 81 with circular frames. Patients required a median of 190 minutes of total operative time and 6 days of hospital stay at a median cost of £16,233 each, median reimbursement was £10,625. The total cost of treatment for all 104 patients was £2,205,611 and total reimbursement was £1,391463, the median deficit per patient being £5825. The overall deficit over the 2 years was £814,148. Conclusions. This study reveals a considerable
Total hip arthroplasty (THA) has become one of the most commonly performed elective procedures. Today, there are nearly 50 000 annual hospitalisations for hip replacement surgery in Canada. This number is projected to increase significantly with the aging population. Periprosthetic joint infection (PJI) is the 3rd leading cause of failure following THA and is reported to occur at an incidence of 1–3%. A two-stage re-vision THA is the current gold standard treatment and this has a tremendous
Background. The
Over 62,000 total hip arthroplasty (THA) cases are performed each year in Canada, with an estimated annual healthcare system cost of $1.4 billion and resulting in 4 billion tonnes of waste annually (6,600 tonnes per day). The aims of this study were 1) Assess satisfaction of current/standard set-up amongst different stakeholders. 2) Assess energy,
Introduction: Low back pain (LBP) is a common symptom in Australian adults. In any 6-month period approximately 10% of Australian adults suffer some significant disability from low back pain. 1. One way of assessing the impact of LBP on a population is to estimate the
INTRODUCTION: Low back pain (LBP) is a common symptom in Australian adults. In any six months period approximately 10% of Australian adults suffer some significant disability from low back pain. 1. One way of assessing the impact of LBP on a population is to estimate the
Due to limitations of existing pharmacological therapies for the management of chronic pain in osteoarthritis (OA), surgical interventions remain a major component of current standard of care, with total joint replacements (TJRs) considered for people who have not responded adequately to conservative treatment. This study aimed to quantify the
The purpose was to define the
A large proportion of our patients are not salaried and many had expressed concerns about the amount of time taken off work following carpal tunnel surgery. Impressions were formed from information given by other health professionals or by friends and relatives who had previously undergone surgery. Some patients declined surgery because of their concerns over this particular issue. We therefore set out to challenge these traditional beliefs. This prompted us to adopt a more aggressive postoperative approach by encouraging immediate and unrestricted hand use following surgery. We found that patients were able to tolerate early activity and were able to return to work sooner than they had expected. For the purposes of this study, our aim was to identify when a return to any form of meaningful employment occurred, such that the individual was earning a salary. Consequently, we did not differentiate between the individual returning to either light or full duties. Subsequently, in a cohort of 494 patients prospectively studied, we have seen 93.1% patients return to work by two weeks and 99.4% by four weeks. This has obvious benefits in terms of reducing loss of income. Individuals undergoing surgery now do not have to be concerned with taking lengthy periods of time off work with the financial implications for them and their families. There are obvious
Introduction and Aims: To define the