The Clinical and Economic Impact of High-Value Cephalomedullary Nail Utilization at a Level II Trauma Center
DOI:
https://doi.org/10.55576/job.v5i3.70Keywords:
High value implants, Cephalomedullary nail, Hip fracture, Cost containment, Value-based careAbstract
Introduction: In the current climate of cost containment and fiscal responsibility, high-value implant alternatives offer a substantial opportunity for savings in the treatment of orthopedic trauma patients. As patents have expired on many commonly used trauma implants, high-value alternatives have become available. The purpose of this study was to examine the clinical and economic impact of a cost containment program utilizing high-value, single lag screw cephalomedullary hip nail implants for treating intertrochanteric femur fractures.
Design: Retrospective comparative cohort study.
Setting: Level II trauma center
Patients/Participants: 885 patients (347 Males and 538 Females) with intertrochanteric femur fractures.
Intervention: Patients treated with high-value single lag screw cephalomedullary implants were compared to those treated with conventional implants during the same period.
Main Outcome Measurements: Operative records were reviewed to identify intraoperative complications, operative time, and estimated blood loss. Cases involving infection, malunion, nonunion, or the need for repeat surgery were documented. Hospital financial records were evaluated to determine implant costs.
Results: 443 patients were treated with the high-value implant, while 442 patients received conventional single lag screw cephalomedullary implants over the same period. No difference was observed in intraoperative complications or estimated blood loss. Operative time was significantly shorter in the high-value implant group (p=2.3E-10). There was no increase in postoperative infection rates, implant complications, malunion, or nonunion. Overall, the hospital saved a total of $512,994 on implant costs.
Conclusions: Implant costs decreased significantly without an increase in complication rates or changes in radiographic outcomes. These savings were essential to our success in the Bundled Payment for Care Improvement (BPCI) initiative. Additionally, the savings can be reinvested into the trauma program in alignment with OTA/AAOS position statements and guidelines, as well as to support gainsharing and co-management initiatives.
Level of Evidence: Level III - Retrospective comparative cohort study
Keywords: Cephalomedullary nail, Hip fracture, High-value implants, Cost containment, Orthopaedic trauma.
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