Aims

Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians’ health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations.

Periprosthetic femoral fracture (PFF) incidence following hip replacement surgery continues to rise. There is a national drive to centralise PFF treatment within specialist centres to improve clinical outcomes and cost-effectiveness. The financial implications of treating PFFs must be analysed to guide allocation of funding.

Data were collected for 129 PFFs admitted from 02/04/2014–19/05/2020. Financial data were provided by the Patient Level Information and Costing Systems (PLICS) team. Primary outcomes were cost, revenue and margin for each PFF. Additional data were collected on length of stay (LOS), critical care requirements and clinical outcomes. Statistical comparisons were made between treatment type (fixation vs revision). Significance was set to p<0.05.

Across the entire cohort, total cost was £2,389,901, total revenue was £1,695,435 and total loss was £694,481. Highest costs were ward stay (£714,591), theatre utilisation (£382,625), and overheads (£249,110). Median cost was £15,863 (IQR, £11,092-£22,221), median revenue was £11,305 (IQR, £7,147-£15,222) and median loss was £3,795 (IQR, £605-£8687). Median LOS was 21 days (IQR 13–34) and 28.7% patients required critical care admission.

Ninety-six patients were treated operatively with either fixation (n=53) or revision (n=43). Median operating time was lower for fixation versus revision (132 [IQR, 115–185] vs 201 [IQR, 159–229] minutes, p=0.001). Median cost (£17,455 [IQR, £13,095-£22,824] vs £17,399 [£13,394-£23,404]) and median loss (£5,774 [IQR, £2,092-£10,472] vs £3,860 [IQR, £96-£7,601]) were similar for fixation and revision (p=0.99 and p=0.18, respectively). Median revenue was greater for revision versus fixation (£13,925 [IQR, £11,294-£17,037] vs £12,160 [IQR, £8,486-£14,390], p=0.02). There was no difference in LOS (21 [13–34] vs 21 [14–30] days, p=0.94), critical care requirements (20 [37.7%] vs 11 [25.6%], p=0.30), reoperations (3 [5.7%] vs 6 [14.0%], p=0.29], local complications (8 [15.1%) vs 12 [27.9%], p=0.20) or systemic complications (11 [20.8%] vs 11 [25.6%], p=0.75) between fixation and revision.

PFF treatment costs are high with inadequate reimbursement through tariff. Work is needed to address this disparity and reduce costs associated with LOS, theatre utilisation and implants. Treatment cost should not be used when deciding between fixation and revision surgery.