HAND & WRIST
Comparison of direct and indirect costs of internal fixation and cast treatment in acute scaphoid fractures: A randomized trial involving 52 patients
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):160 Acta Orthop. 2007 Oct;78(5):672-952 patients were randomized to receive one of two treatments for acute scaphoid fracture. One group underwent a surgical (internal fixation) procedure while the second group underwent a closed (cast treatment) procedure. The primary outcomes examined were total (indirect and direct) costs of either treatment as well as length of work absences. Results demonstrated that there was a higher total cost incurred from surgical treatment in both manual and non-manual workers. However, closed treatment patients had longer work absences and higher work disability costs.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
4/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
2/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Acute scaphoid injuries are commonly seen in younger working individuals and the method of treatment is often non-surgical (cast immobilization). This type of treatment can result in long absences from work and incur large financial losses. The most cost-efficient method of treatment (e.g. surgical or non-surgical) for acute scaphoid fractures has not been determined. This study aim to identify the most cost-efficient method of treating patients with an acute scaphoid fracture.
Was war die wichtigste Forschungsfrage?
What are the outcomes of direct and indirect costs in performing a surgical (internal fixation) procedure compared to a non-surgical (cast treatment) procedure in patients with an acute scaphoid fracture?
Was waren die wichtigsten Ergebnisse?
- There was a numerically but not statistically significant greater median time for work absence in the cast-treated group compared to the surgery group. (Cast: 74 days, Surgery: 39 days) (p=0.32)
- Workers that performed manual work had a longer work absence compared to workers that were non-manual or self-employed (Manual: Median 84 days, Non-manual: Median 16 days) (p<0.001). Manual workers also had a longer time off work following cast treatment when compared to surgery. (Manual: Median 100 days, Non-manual: Median 61 days) (p=0.03). No difference existed between treatment groups when comparing absence from work for patients who were non-manual workers/self employed (p=0.5).
- The cast group had lower hospital costs compared to the surgery group. (p<0.001) and the total cost was lower in the cast group.
- Manual workers had higher work disability costs and total costs compared to the non-manual workers. (p<0.001)
- Non-manual workers had lower total costs after cast treatment compared to surgery. (p=0.05)
- The surgical group had 3 complications while the non surgical group had 1. 2 of the complications in the surgical group were implant related.
Was sollte ich mir besonders merken?
There was a higher total cost incurred from surgical treatment in both manual and non-manual workers. However, closed treatment patients had longer work absences and higher work disability costs when compared to the surgery-treated group.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
Manual workers receiving non-operative treatment for a scaphoid fracture will have a longer work-absence, lower hospital cost, but higher disability cost than manual workers receiving surgical treatment. Non-manual/self-employed workers undergoing non-operative intervention will have shorter work absence, lower hospital cost, and lower work disability costs when compared to non-manual workers undergoing surgical treatment. The authors of this study suggest that surgical treatment should be considered in situations where cast-treatment will hinder an individual's ability to work.
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