PSU5 COMPLICATIONS, HEALTH RESOURCE UTILIZATION AND COSTS ASSOCIATED WITH HARDWARE REMOVAL WITHIN 1-YEAR AFTER OPEN REDUCTION INTERNAL FIXATION OF TIBIA OR FIBULA FRACTURES

Abstract

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. 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. 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). 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.