The impact of compartment syndrome on hospital length of stay and charges among adult patients admitted with a fracture of the tibia.
ABSTRACT To compare hospital charges and length of stay in a series of adult patients with isolated, otherwise uncomplicated tibia fractures with and without acute compartment syndrome (ACS).
Retrospective case-control study.
Urban Level I trauma center.
Forty-six previously healthy adults with isolated tibia fractures (open or closed), with or without ACS but without other complication, associated injury, or social circumstance that influenced hospital stay or charges.
Intramedullary nailing in all patients with immediate fasciotomy and delayed fasciotomy closure in the subset of patients who developed ACS.
Hospital length of stay in days and hospital charges.
Forty-six otherwise uncomplicated patients with isolated tibial shaft fractures were identified. Twelve fractures were open. ACS occurred in five patients, all with closed fractures. In 41 patients without ACS (12 open fractures, 29 closed fractures), the mean hospital stay was 3.0 days and mean hospital charges were $23,800. The five patients with ACS underwent a mean of 1.6 additional surgeries to treat the fasciotomy wound, were hospitalized for a mean of 9.0 days, and the mean hospital charges were $49,700. These differences were highly significant for hospital stay (P < 0.005) and charges (P < 0.00004). In contrast, there were no differences in length of stay or hospital charges in patients with closed or open fractures, respectively.
The cost of ACS is significant, resulting in hospital stays that are increased threefold and hospital charges that are more than doubled in this cohort of patients. The impact of compartment syndrome on these factors was more important than whether the fracture was open or closed. In addition to the obvious benefit to the patient, methods that decrease the incidence of compartment syndrome and need for fasciotomy such as improved diagnosis to prevent unnecessary fasciotomy and methods to reduce intramuscular pressure and avoid fasciotomy in cases of incipient ACS would also be of value in reducing medical costs.
- SourceAvailable from: Bernat De Pablo Márquez
Article: Síndrome compartimental agudoSEMERGEN - Medicina de Familia 03/2014;
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ABSTRACT: Compartment syndrome is an elevation of intracompartmental pressure to a level that impairs circulation. While the most common etiology is trauma, other less common etiologies such as burns, emboli, and iatrogenic injuries can be equally troublesome and challenging to diagnose. The sequelae of a delayed diagnosis of compartment syndrome may be devastating. All care providers must understand the etiologies, high-risk situation, and the urgency of intervention.HSS Journal 07/2014; 10(2):143-52.
Article: [Acute compartmental syndrome.]SEMERGEN - Medicina de Familia 03/2014;