Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England

Simone Wolf; Abhishek S Chitnis; Anandan Manoranjith; Mollie Vanderkarr; Javier Quintana Plaza; Laura V Gador; Chantal E Holy; Charisse Sparks; Simon M Lambert

doi:10.1186/s12891-022-05075-5

Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England

BMC Musculoskelet Disord. 2022 Feb 9;23(1):135. doi: 10.1186/s12891-022-05075-5.

Authors

Simone Wolf¹, Abhishek S Chitnis², Anandan Manoranjith³, Mollie Vanderkarr⁴, Javier Quintana Plaza⁵, Laura V Gador⁶, Chantal E Holy⁷, Charisse Sparks⁴, Simon M Lambert⁸

Affiliations

¹ Synthes GmbH, Zuchwil, Switzerland.
² Medical Devices Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA.
³ Mu Sigma, Bangalore, India.
⁴ DePuy Synthes, Inc., West Chester, PA, USA.
⁵ Johnson and Johnson, Madrid, Spain.
⁶ Johnson and Johnson GmbH, Neuss, Germany.
⁷ Medical Devices Epidemiology, Johnson & Johnson, New Brunswick, NJ, USA. choly1@its.jnj.com.
⁸ University College London Hospital, London, UK.

Abstract

Introduction: The clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database.

Methods: CPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010-2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery.

Results: 21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)-84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156).

Conclusions: Complication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need.

Keywords: Clavicle; Cohort Studies; Cost of Illness; Fractures, Bone; Postoperative Complications; Reoperation; United Kingdom.

MeSH terms

Adult
Bone Plates
Clavicle* / surgery
Female
Fracture Fixation, Internal
Fractures, Bone* / epidemiology
Fractures, Bone* / surgery
Health Care Costs
Humans
Male
Reoperation
Retrospective Studies
State Medicine
Treatment Outcome