TY  - JOUR
T1  - An Economic Evaluation of a Systems-Based Strategy to Expedite Surgical Treatment of Hip Fractures
AU  - Dy, Christopher J.
AU  - McCollister, Kathryn E.
AU  - Lubarsky, David A.
AU  - Lane, Joseph M.
Y1  - 2011/07/20
N1  - 10.2106/JBJS.I.01132
JO  - The Journal of Bone & Joint Surgery
SP  - 1326
EP  - 1334
VL  - 93
IS  - 14
N2  - Update 
  This article was updated on August 24, 2011, because of a previous error. In Figure 1, the labels that had previously read "Alive at 1 year" now read "Deceased at 1 year," and vice versa.Background: 
  A recent systematic review has indicated that mortality within the first year after hip fracture repair increases significantly if the time from hospital admission to surgery exceeds forty-eight hours. Further investigation has shown that avoidable, systems-based factors contribute substantially to delay in surgery. In this study, an economic evaluation was conducted to determine the cost-effectiveness of a hypothetical scenario in which resources are allocated to expedite surgery so that it is performed within forty-eight hours after admission.Methods: 
  We created a decision tree to tabulate incremental cost and quality-adjusted life years in order to evaluate the cost-effectiveness of two potential strategies. Several factors, including personnel cost, patient volume, percentage of patients receiving surgical treatment within forty-eight hours, and mortality associated with delayed surgery, were considered. One strategy focused solely on expediting preoperative evaluation by employing personnel to conduct the necessary diagnostic tests and a hospitalist physician to conduct the medical evaluation outside of regular hours. The second strategy added an on-call team (nurse, surgical technologist, and anesthesiologist) to staff an operating room outside of regular hours.Results: 
  The evaluation-focused strategy was cost-effective, with an incremental cost-effectiveness ratio of $2318 per quality-adjusted life year, and became cost-saving (a dominant therapeutic approach) if ≥93% of patients underwent expedited surgery, the hourly cost of retaining a diagnostic technologist on call was <$20.80, or <15% of the hospitalist's salary was funded by the strategy. The second strategy, which added an on-call surgical team, was also cost-effective, with an incremental cost-effectiveness ratio of $43,153 per quality-adjusted life year. Sensitivity analysis revealed that this strategy remained cost-effective if the odds ratio of one-year mortality associated with delayed surgery was >1.28, ≥88% of patients underwent early surgery, or ≥339.9 patients with a hip fracture were treated annually.Conclusions: 
  The results of our study suggest that systems-based solutions to minimize operative delay, such as a dedicated on-call support team, can be cost-effective. Additionally, an evaluation-focused intervention can be cost-saving, depending on its success rate and associated personnel cost.Level of Evidence: 
  Economic and decision analysis Level II. See Instructions to Authors for a complete description of levels of evidence.
SN  - 0021-9355
M3  - doi: 10.2106/JBJS.I.01132
UR  - http://dx.doi.org/10.2106/JBJS.I.01132
ER  -