Abstract
BackgroundTibia shaft fractures (TSF) are common for men and women and cause substantial morbidity, healthcare use, and costs. The impact of nonunions on healthcare use and costs is poorly described. Our goal was to investigate patient characteristics and healthcare use and costs associated with TSF in patients with and without nonunion.MethodsWe retrospectively analyzed medical claims in large U.S. managed care claims databases (Thomson Reuters MarketScan®, 16 million lives). We studied patients ≥ 18 years old with a TSF diagnosis (ICD-9 codes: 823.20, 823.22, 823.30, 823.32) in 2006 with continuous pharmaceutical and medical benefit enrollment 1 year prior and 2 years post-fracture. Nonunion was defined by ICD-9 code 733.82 (after the TSF date).ResultsAmong the 853 patients with TSF, 99 (12%) had nonunion. Patients with nonunion had more comorbidities (30 vs. 21, pre-fracture) and were more likely to have their TSF open (87% vs. 70%) than those without nonunion. Patients with nonunion were more likely to have additional fractures during the 2-year follow-up (of lower limb [88.9% vs. 69.5%, P < 0.001], spine or trunk [16.2% vs. 7.2%, P = 0.002], and skull [5.1% vs. 1.3%, P = 0.008]) than those without nonunion. Nonunion patients were more likely to use various types of surgical care, inpatient care (tibia and non-tibia related: 65% vs. 40%, P < 0.001) and outpatient physical therapy (tibia-related: 60% vs. 42%, P < 0.001) than those without nonunion. All categories of care (except emergency room costs) were more expensive in nonunion patients than in those without nonunion: median total care cost $25,556 vs. $11,686, P < 0.001. Nonunion patients were much more likely to be prescribed pain medications (99% vs. 92%, P = 0.009), especially strong opioids (90% vs. 76.4%, P = 0.002) and had longer length of opioid therapy (5.4 months vs. 2.8 months, P < 0.001) than patients without nonunion. Tibia fracture patterns in men differed from those in women.ConclusionsNonunions in TSF’s are associated with substantial healthcare resource use, common use of strong opioids, and high per-patient costs. Open fractures are associated with higher likelihood of nonunion than closed ones. Effective screening of nonunion risk may decrease this morbidity and subsequent healthcare resource use and costs.
Highlights
Tibia shaft fractures (TSF) are common for men and women and cause substantial morbidity, healthcare use, and costs
This study addressed an important gap in the literature: the lack of recent and broadly representative data on healthcare use and cost of tibia fracture treatment depending on the nonunion status
We found that patients with nonunion were more likely to experience additional fractures in the study period than those without nonunion, which could have increased their likelihood of receiving NSAIDs, opioids, or both
Summary
Tibia shaft fractures (TSF) are common for men and women and cause substantial morbidity, healthcare use, and costs. Tibia shaft fractures are common but unanticipated trauma in adults resulting in painful and prolonged recovery, often associated with complications. The U.S National Center for Health Statistics reported annual incidence of 492,000 fractures of tibia, fibula, and ankle [1]. Tibia and fibula fractures annually result in 77,000 hospitalizations accounting for 569,000 hospital days and 825,000 physician office visits [2]. The U.S Agency for Healthcare Research and Quality (AHRQ) reported 151,966 hospital discharges for which tibia/fibula fracture diagnosis was a reason for a principal procedure in 2007 (Healthcare Cost and Use Project, AHRQ) [3]. Tibia fractures are treated medically, and healthcare use depends on treatment options, which, in turn, vary by injury type and severity and the presence of complications [5,7]
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