Operative vs. conservative treatment of AC-Joint Dislocations Rockwood grade ≥ III -An economical and clinical evaluation.

Autor: Niehaus R; Apollon Hochschule für Gesundheitswirtschaft, Apollon Hochschule für Gesundheitswirtschaft, Universitätsallee 18, 28359, Bremen, Germany. richard.niehaus@web.de.; Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, 5404, Switzerland. richard.niehaus@web.de., Schleicher A; Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, 5404, Switzerland., Ammann E; Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, 5404, Switzerland., Kriechling P; Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, 5404, Switzerland., Lenz CG; Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, 5404, Switzerland., Masanneck M; Apollon Hochschule für Gesundheitswirtschaft, Apollon Hochschule für Gesundheitswirtschaft, Universitätsallee 18, 28359, Bremen, Germany., Hodel S; Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, 5404, Switzerland., Eid K; Department of Orthopedic Surgery, Kantonsspital Baden, Im Ergel 1, Baden, 5404, Switzerland.
Jazyk: angličtina
Zdroj: Cost effectiveness and resource allocation : C/E [Cost Eff Resour Alloc] 2023 Sep 13; Vol. 21 (1), pp. 63. Date of Electronic Publication: 2023 Sep 13.
DOI: 10.1186/s12962-023-00468-2
Abstrakt: Introduction: Acromioclavicular joint dislocations (ACD) are one of the most common shoulder injuries. There is no consensus in how to treat higher graded ACD ≥ Rockwood grade III. This study compares operative versus conservative treatment regarding costs and clinical outcome parameters.
Materials and Methods: This retrospective, consecutive case-control-study includes 14 patients. Seven operatively treated patients were matched, by Rockwood grade, with seven conservatively treated patients. The cost was extracted out of the clinical- and insurance-based cost sheets and furthermore these include the loss of earnings. Clinical examination, demographic data as well as different outcome-questionnaires were recorded.
Results: There were no significant differences between operative and conservative treated patients for outcome Questionnaires. Of note, there was a significantly higher incidence of tenderness over the AC-joint (p = 0.0038) postoperatively. As expected, economical evaluation showed various findings in favor of the conservative treatment. The costs for medical services (11012.39vs.1163.81USD; p = 0.0061), days of hospitalization (3.3vs.0days; p < 0.0001); total cost for medical treatment (30262.17 vs. 7833.82 USD; p = 0.0358) were significantly higher in the operative group.
Conclusion: Even with a limited case number and a retrospective study design almost all clinical results were equal in both groups. Operative therapy of higher graded ACDs (Rockwood > III) compared to conservative is economically inefficient. Under consideration of clinical comparable results, indications for operative treatment should be set very carefully.
(© 2023. BioMed Central Ltd., part of Springer Nature.)
Databáze: MEDLINE
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