New Economic Study Published in the Journal of Bone & Joint Surgery Identifies Two Cost-effective Hospital Strategies for Expediting Hip Fracture Surgery

Reducing Admission to Surgery Time to 48 hours or Less Has Potential to Improve Patient Outcomes

Yahoo! Finance—July 20, 2011

An economic study in the current issue of the Journal of Bone and Joint Surgery (JBJS) identifies two cost-effective strategies for hospitals to expedite surgery in hip fracture patients, and potentially improve patient outcomes.

"Recent studies suggest that mortality within one year after hip fracture repair increases significantly if the time from hospital admission to surgery exceeds 48 hours and that systems-based factors contribute to delay in surgery," said Christopher J. Dy, MD, MSPH, orthopaedic surgery resident physician at Hospital for Special Surgery in New York and the study's lead author. "Our study evaluated whether two strategies for reallocating hospital resources provide cost-effective means of optimizing care. The results show that systems-based solutions to minimize operative delay, such as a dedicated on-call support team, can be cost-effective. In addition, an evaluation-focused intervention can be potentially cost-saving in a high-volume surgical center."

In a separate Commentary and Perspective, Mininder S. Kocher, MD, MPH, associate director of the Division of Sports Medicine and director of the Clinical Effectiveness Research Unit at Children's Hospital Boston, said the study addresses "an important clinical problem that results in high costs and high mortality and morbidity: hip fracture. The annual health care cost associated with hip fractures in the U.S. is estimated to exceed $10 billion, and the one year mortality rate associated with a hip fracture has been estimated to be between 12 percent and 37 percent." He urged both orthopaedic surgeons and hospitals to consider implementing such strategies and evaluating their costs and outcomes in prospective studies. 

Study Details and Major Findings

• Dy and his colleagues created a decision tree to assess the cost-effectiveness of two potential strategies for reducing time to surgery to less than 48 hours. One strategy focused on speeding up preoperative evaluation to ensure the necessary diagnostic tests and medical evaluation could be conducted at any hour, and the second strategy added an on-call team, including a nurse, surgical technologist, and anesthesiologist to perform the surgery outside of regular hours. The model considered a number of factors, including personnel cost, patient volume, percentage of patients receiving surgical treatment within 48 hours and mortality associated with delayed surgery.
• The first strategy had a cost-effectiveness ratio of $2318 per quality-adjusted life year (QALY), which is below the widely accepted threshold of $50,000 per QALY for interventions that should be considered for implementation. The strategy also became cost-saving if 93 percent or more of patients underwent expedited surgery.
• The second strategy had an incremental cost-effectiveness ratio of $43,153 per QALY, and remained cost effective if the odds ratio of one-year mortality associated with delayed surgery was greater than 1.28, more than 88 percent of patients underwent early surgery, or more than 339.9 patients with a hip fracture were treated annually.

The study is entitled, "An Economic Evaluation of a Systems-Based Strategy to Expedite Surgical Treatment of Hip Fractures." In addition to Dr. Dy, the authors included Kathryn E. McCollister, PhD assistant professor/health economist, Department of Epidemiology and Public Health at the University of Miami School of Medicine; David A. Lubarsky, MD, MBA, professor and chairman of the Department of Anesthesiology, Perioperative Medicine and Pain Management at the University of Miami School of Medicine, chief of the Anesthesiology Service at Jackson Memorial Hospital, professor of management at University of Miami School of Business; and senior author Joseph M. Lane, MD, chief of the metabolic bone disease service and associate director of the Orthopaedic Trauma Service at Hospital for Special Surgery.

Disclosure: The authors have nothing related to this study to disclose.