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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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.
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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.
免責事項
このページに記載されている内容は、情報提供のみを目的としたものであり、専門的な医療アドバイス、診断、治療の代わりとなるものではありません。治療が必要な場合は、必ず医師の診断を仰ぐか、最寄りの救急外来を受診してください。このページに記載されている内容に関して個人が表明した意見、信念、見解は、OrthoEvidenceの意見、信念、見解を反映するものではありません。
0の4 月間無料記事のロック解除
