F. Gani1, N. Nagarajan1, H. Alshaikh1, C. K. Zogg1, H. Alturki1, S. Selvarajah1, A. Najafian1, L. Kodadeck1, C. G. Velopulos2, D. T. Efron2, E. B. Schneider1, A. H. Haider1 1Johns Hopkins University School Of Medicine,Center For Surgical Trials And Outcomes Research, Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA
Introduction: Healthcare policy efforts are increasingly geared toward providing higher quality care at lower costs. For fractures alone, healthcare spending in the United States is estimated to be >$20 billion per year. Previous data for severely injured patients suggest an improvement in survival at trauma centers. Little is known about possible differences in patient charges for the management of non-life threatening conditions at trauma centers vs. non-trauma center hospitals. Using uncomplicated, closed tibial fractures as an index condition, this study examined possible differences in patient charges at level 1 trauma centers (TC) compared with non-trauma centers (NTC).
Methods: Data from the 2006-2011 HCUP Nationwide Emergency Department Sample (NEDS) were queried and patients with a primary diagnosis of closed tibial fracture who underwent routine same-day discharge from the emergency department (ED) were identified using ICD-9-CM diagnosis codes. Patients with an Abbreviated Injury Scale (AIS) extremity score of ≤2 were included in the study cohort. Patients with other major concomitant injuries listed in diagnosis positions 2-15 were excluded as were individuals who had a calculated AIS >0 in any region except “extremity.” Patient demographics, injury and hospital characteristics were compared between TC and NTC using χ² and t-tests. Wilcoxon rank-sum tests examined TC vs. NTC difference in median patient charges. A generalized linear model with a gamma distribution and robust error variances (adjusted for age, sex, insurance status, Charlson comorbidity index, income quartile, mechanism of injury and hospital region) examined differences in mean total charges between patients treated at TC and NTC.
Results: A total of 15,773 patients met inclusion criteria. 1,845 patients were treated at TC and 13,361 patients at NTC. Patients at TC were younger compared to those at NTC, median age 44 (IQR = 32-56) and 48 years (IQR = 38-60) respectively. Proportionally fewer female patients were treated at TC vs. NTC (44.77% vs. 51.21%, p<0.001). Median total charges were higher at TC vs. NTC [$2,278, (IQR $1,259-$4074) vs. $1,351, (IQR $848-$2,313), p<0.001]. Adjusted charges for management in the ED were 94% higher at TC vs. NTC [$3,781 (95%CI $3,548-$4,013) vs. $1,951 (95% CI $1,902-$2,000) p<0.001].
Conclusion: Patients undergoing routine same-day discharge after ED treatment of an uncomplicated tibial fracture at TC incur substantially higher charges than otherwise similar patients treated at NTC. Better understanding the factors underlying the differences in charges observed between TC vs. NTC facilities may enable substantial savings to the healthcare system.