Cost, profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation

Abstract

Study DesignRetrospective cost-of-illness study. IntroductionInjuries to the hand and wrist are common. Most uncomplicated and stable upper extremity injuries recover with conservative management; however, some require surgical intervention. The economic burden on the health care system from such injuries can be considerable. Purpose of the StudyTo estimate the economic implications of surgically managed acute hand and wrist injuries at one urban health care network. MethodsUsing 33 primary diagnosis ICD-10 codes involving the hand and wrist, 453 consecutive patients from 2014 to 2015 electronic billing records who attended the study setting emergency department and received consequent surgical intervention and outpatient follow-up were identified. Electronic medical records were reviewed to extract demographic data. Costs were calculated from resource use in the emergency department, inpatient, and outpatient settings. Results are presented by demographics, injury type, mechanism of injury, and patient pathway. ResultsTwo hundred and twenty-six individuals (n 1⁄4 264 surgeries) were included. The total cost of all injuries was $1,204,606. The median cost per injury for non-compensable cases (n = 191) was $4508 [IQR $3993-$6172] and $5057 [IQR $3957-$6730] for compensable cases (n = 35). The median number of postoperative appointments with a surgeon was 2.00 (IQR 1.00-3.00) for both compensable and non-compensable cases. The number of hand therapy appointments for non-compensable cases and compensable cases was 4 [IQR 2-6] and 2 [IQR 1-3], respectively. DiscussionFindings of this investigation highlight opportunities for health promotion strategies for reducing avoidable injuries and present considerations for reducing cost burden by addressing high fail to attend (FTA) appointment rates. ConclusionSurgically managed hand and wrist injuries contribute to a significant financial burden on the health care system. Further research using stringent data collection methods are required to establish epidemiological data and national estimates of cost burden.