The financial cost of managing tibial plateau fractures at a major trauma centre

Abstract

Introduction: Tibial plateau fractures can be challenging to manage, and as such, they are often referred to tertiary referral centres for specialist input, and with the advent of Major Trauma Centres, this is likely to increase. The financial implications of this are unknown. The study aims were to: (1) analyse the cost of tibial plateau fracture management at a major trauma centre, (2) identify the proportion each aspect of the admission contributed to overall cost, and (3) investigate how tibial plateau fractures were coded. Patients and methods: A retrospective review of all patients presenting between July 2010 and October 2011 with a tibial plateau fracture was performed. Data were collected on all aspects of each patient’s admission. The cost for each part of the admission was obtained from the institution finance department with the total cost of treating tibial plateau fractures in each patient subsequently calculated. Results: Forty tibial plateau fractures were included (mean age 43.6 years; 70.0% male). Fractures occurred as a component of polytrauma in 37.5% with operative fixation performed in 65%. Mean total cost of treating tibial plateau fractures was £4941 with ward costs (57.6%) and operative costs (34.1%) accounting for the majority. Mean cost of managing fractures sustained in polytrauma (£3073) remained significantly higher ( p = 0.012) than those sustained in isolation (£1401) when excluding ward costs and adjusting for length of stay. This was true irrespective of Schatzker grade. No specific injury code was available for tibial plateau fractures. In patients sustaining polytrauma, the tibial plateau fracture was never coded as the primary injury, but instead using a subsidiary code, which attracted less remuneration. Conclusions: Tibial plateau fractures sustained during polytrauma incurred the highest costs. As ward costs contribute to the majority of overall cost, it is recommended that mechanisms are in place to facilitate early discharge back to referring centres or to provide remuneration for incurred admission costs once definitive fracture fixation has been performed. Hospital coding must be modified to more accurately reflect the injuries sustained.