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Social Insurance Costs and Impairment in Displaced Wrist Fractures in Young and Elderly Patients Th . MULIER , P . MILANTS , P. DONCEEL Werchter / Heilig Hart and UZ Leuven Elton John , Rock Werchter 2007. INTRODUCTION. Case 1. Suicide attempt, 33 y nurse: S.I. cost 9000 E ! - PowerPoint PPT Presentation
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Belgian Hand Group, 17 11 2007
Social Insurance Costs and Impairment in Displaced Wrist Fractures in Young and Elderly Patients
Th. MULIER , P. MILANTS , P. DONCEEL
Werchter / Heilig Hart and UZ Leuven
Elton John , Rock Werchter 2007
Belgian Hand Group, 17 11 2007
INTRODUCTION
Belgian Hand Group, 17 11 2007
Case 1
Suicide attempt, 33 y nurse: S.I. cost 9000 E !
Total Medical Cost (TMC) : 3166 E
Temp Work incapacity (TWC) : 5600 E
No disability cost, RTW: 6 months 0 E
Belgian Hand Group, 17 11 2007
Belgian Hand Group, 17 11 2007
Case 2Construction worker, 44 y: 40% Econ.loss !
Fell while working at podium
TMCost: 2700 E, TWC: 3850 E
11% impairment, 11% disability: 3650 E / year x 21
Change of work …
Belgian Hand Group, 17 11 2007
Belgian Hand Group, 17 11 2007
• Most common fracture in elderly• Increasing in young adults (“hype”)
No studies about costs and impairment!
Belgian Hand Group, 17 11 2007
PURPOSE Analyze the (SI) cost and impairment in
patients with a displaced distal radius fracture (DRF) in two different groups:
1) young economically active 2) elderly patients
Belgian Hand Group, 17 11 2007
Types of Costs
• Direct Medical Cost (DMC)
• Medical Cost for After Treatment
= Total Medical Cost (TMC)
• Temporary Work Incapacity Cost (TWC)
• Impairment/Disability Cost (DC)
= Overall cost
Belgian Hand Group, 17 11 2007
MATERIAL AND METHODS
Belgian Hand Group, 17 11 2007
MATERIAL (n=485) Group A: Young ec. active- 105 cases with DRF 17 files medicolegal consults
Group B: Elderly,non ec. active- 380 cases with DRF
Belgian Hand Group, 17 11 2007
METHODS
File review / File review / Stat.Stat.data analysisdata analysis (+ML,MDB, KULeuven)
:
1. Direct/total medical costs (Gr A + B ,485 cases)
2. Work incapacity period :time, grade, cost ( Gr. A,105)
3. Disability for work % and impairment % (OBSI scale) (Gr B, 17 medicolegal cases)
Belgian Hand Group, 17 11 2007
METHOD (N=105)
Assessment (group A):
- Functional: PRWE 100- p score
- Clinical: Grip strength, ROM (30 p)
- Radiological: Criteria
- Complications: Malunion, CRPS…
Pols1.mpg
Belgian Hand Group, 17 11 2007
Standard treatment protocol
Frykman classification 1-8
Dorsal displaced:• Kapandji (1-4): Displaced, non
comm.• Ext fixation: Displaced, comminuted • Ext fixation + pin: Displaced, comminuted
Volar displaced:• Plating: Smith fractures
Belgian Hand Group, 17 11 2007
• Kap Pinning:60%
• Ext fixation:21%• Ext fix + pinning:9%
• Volar Plating:10%
Belgian Hand Group, 17 11 2007
RESULTS
Belgian Hand Group, 17 11 2007
1.Direct medical cost
1455 Euro (range 645-18650)
• 19 % preoperative costs, 63 % cost for technical acts (surgery, anaesthesia, implant material) ,18 % hospital stay
Belgian Hand Group, 17 11 2007
Direct Medic.Costs / Gender:
1258 E (male) versus 1522 E (female)(P<0,04)
Belgian Hand Group, 17 11 2007
Direct Medical Cost
• Non Significant :
Cost versus age, ASA, functional status residence prior to admission
• Significant :
Cost versus surgeon, type of treatment, gender
Belgian Hand Group, 17 11 2007
2. Temporary work incapacity (N=105)
• Duration of work incapacity: mean 73 days (range: 1–396)
• Cost of temporary work incapacity: 2244 E
Belgian Hand Group, 17 11 2007
3. Impairment / Disability: 7,4%
Kapandji 6 %
Plate osteosynthesis 8%
External fixation 8%
Ext fixation plus pinning 9,4%
• Cost: ? (1850-8966 E/year) times 25 (50000E)• Predictive parameters: preop XR, CRPS, DIC
Belgian Hand Group, 17 11 2007
4. Return to work:
72% : same work, 12 % Half time
12% : changed to another profession
16% : remained on sick leave !
• Higher education: pos. effect on outcome, quicker RTW
Belgian Hand Group, 17 11 2007
DISCUSSION
Belgian Hand Group, 17 11 2007
1. SI Cost : 4105 Euro
Two studies in literature:
- Paris study (1999): DMCost 800 E
- London study (1968): comp. cost: 85 P
Our study: 1960 E / 2244 E / (50000 E)
- Reduction of costs ? difficult …
Belgian Hand Group, 17 11 2007
2.Impairment: 7,3%
- No correl. between PRWE and impairment %
- Should also include radiological criteria, clinical and disab. Measurements
- High cost (mean 50000 E)
Belgian Hand Group, 17 11 2007
3.Duration work incapacity/ RTW
1.Duration: Our series: 11 weeks (73 days)
Literature: 5-14 weeks
2 .Return to work:Our series: 84% RTW, 16% permanent WI !
Literature: 72-93% RTW
Belgian Hand Group, 17 11 2007
4.Which type of treatment ?
• Best: Kapandji > Plating> Ext fixation
• Biassed …
Belgian Hand Group, 17 11 2007
5. Limitations in our study
• Total cost of DRF ? (salary cost?, total psych impact?, production loss?)
• Too small subgroups (in group A)
• Difficult to compare with other countries
• Access to figures/costs of insurances
• Costs depends upon surgeon, hospital, (univ. X 2)…
Belgian Hand Group, 17 11 2007
CONCLUSIONS
Belgian Hand Group, 17 11 2007
CONCLUSIONS (1)
1. Cost : 4105 Euro (54105 E), higher in female patients. The overall cost is higher in younger patients. Cost of ext fixation and plate fixation is higher then kapandji pinning.
2. In economically active patients, the most important predictive parameter is education level, prereduction shortening and injury compensation.
Belgian Hand Group, 17 11 2007
CONCLUSIONS (2)
3. Permanent work incapacity is seen in 16% of the operatively treated cases.
4. A comprehensive view after DRF requires impairment and disability measurements.
Belgian Hand Group, 17 11 2007
Thanks !
Dr P .Donceel, L. Desmet, M. Bossens, M. Dubois