Cost-utility analysis of extensile lateral approach versus sinus tarsi approach in Sanders type II/III calcaneus fractures

Zihua Li,Fajiao Xiao,Hui Huang,Haichao Zhou,Shaochen Xu,Xinbo Wu,Yunfeng Yang

doi:10.1186/s13018-020-01963-5

Zihua Li, Fajiao Xiao + Show 5 more

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https://doi.org/10.1186/s13018-020-01963-5

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Abstract

BackgroundExtensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons and comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of cost-utility analysis (CUA) about optimal healthcare for type II/III calcaneus fracture.MethodA single-center, retrospective study was conducted in which basic characteristics, clinical outcomes, and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY.ResultsOne hundred nine patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory, and radiographic evaluation expense, surgery, anesthesia, and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group (P < .001, P = .008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days (P < .001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8 ± 2835.2/QALY and $7914.9 ± 1822.0/QALY respectively, and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference.ConclusionBoth ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials.Level of evidence5

Highlights

Extensile lateral approach had been recognized as the gold standard technique for displaced intraarticular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons and comparative clinical outcome was shown in both techniques
sinus tarsi approach (STA) seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials
General information We conducted a retrospective review of 109 patients (62 in the extensile lateral approach (ELA) group and 47 in the STA group) who had been diagnosed as type II/III calcaneus fracture and had undergone open reduction and internal fixation (ORIF) surgery via ELA or STA from January 2013 to October 2018

Summary

Introduction

Extensile lateral approach had been recognized as the gold standard technique for displaced intraarticular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons and comparative clinical outcome was shown in both techniques. Surgical treatment is necessary, and open reduction and internal fixation (ORIF) via extensile lateral approach (ELA) have been considered as the gold standard in the management of type II/III calcaneus fracture for its clear visualized for reduction and favorable outcomes in long-term [10,11,12,13]. Many investigators and surgeons have advocated using sinus tarsi approach (STA) for its lower reported wound complications rate, lower visual analog pain scale levels, comparative clinical outcomes, and increased overall satisfaction [24,25,26], and there has been a trend toward this technique in recent times. The optimal surgical approach for accurate reduction of DIACFs still remains controversial

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