Comparison of direct surgical cost for humeral shaft fracture fixation: open reduction internal fixation versus intramedullary nailing

Andrew R Stephens; Angela P Presson; Chong Zhang; Brian Orleans; Mike Martin; Andrew R Tyser; Nikolas H Kazmers

doi:10.1016/j.jseint.2021.04.005

Comparison of direct surgical cost for humeral shaft fracture fixation: open reduction internal fixation versus intramedullary nailing

JSES Int. 2021 Apr 30;5(4):734-738. doi: 10.1016/j.jseint.2021.04.005. eCollection 2021 Jul.

Authors

Andrew R Stephens^{1

2}, Angela P Presson³, Chong Zhang³, Brian Orleans³, Mike Martin², Andrew R Tyser⁴, Nikolas H Kazmers⁴

Affiliations

¹ School of Medicine, University of Utah, Salt Lake City, UT, USA.
² Health Hospitals and Clinics, University of Utah, Salt Lake City, UT, USA.
³ Division of Public Health, University of Utah, Salt Lake City, UT, USA.
⁴ Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.

Abstract

Background and/or hypothesis: Prior literature has supported similar complication rates and outcomes for humeral shaft fractures treated with open reduction internal fixation (ORIF) with a plate/screw construct versus intramedullary nailing (IMN). The purpose of this study is to determine whether surgical encounter total direct costs (SETDCs) differ between ORIF and IMN for these fractures.

Methods: Adult patients (≥ 18 years) treated for isolated humeral shaft fractures by ORIF or IMN between June 18, 2014 and June 17, 2019 at a single tertiary academic center were available for inclusion. SETDCs for ORIF and IMN groups, obtained through our institution's information technology value tool, were adjusted to 2019 US dollars and converted to relative costs per institutional policy. SETDCs for ORIF and IMN were compared using the Wilcoxon rank-sum test.

Results: Demographic factors did not differ between ORIF and IMN cohorts with the exception of age (mean of 18.6 years older for IMN; P < .001) and American Society of Anesthesiologist class (higher for IMN; P = .029). Substantial cost variation was observed among the 39 included ORIF and 21 IMN cases. Costs pertaining to operating room utilization (P = .77), implants (P = .64), and the recovery room (P = .27) were similar for ORIF and IMN, whereas supply costs were significantly greater for IMN with a median (interquartile range) of 0.21 (0.17 ∼ 0.28), more than twice the supply costs of ORIF (0.09 [0.05 ∼ 0.13], P < .001). The SETDC of IMN was significantly greater than that of ORIF (median [interquartile range]:1.00 [0.9 to 1.13] vs. 0.83 [0.71∼1.05], respectively; P = .047).

Discussion and/or conclusion: Our study found that the SETDC for humeral shaft fracture fixation was greater for IMN than for ORIF, although patient cohorts differed significantly with respect to age and the American Society of Anesthesiologist class. Surgeons should take these findings into consideration when consenting patients with humeral shaft fractures for the appropriate fixation type.

Keywords: Cost; Humeral shaft fractures; Value.

Grants and funding

UL1 TR002538/TR/NCATS NIH HHS/United States