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Institutional Variation in Surgical Rates and Costs for Pediatric Distal Radius Fractures: Analysis of the Pediatric

Susan T Mahan1, Leslie A Kalish2, Apurva S Shah3

  • 1Boston Children's Hospital, Department of Orthopaedics, Boston, MA.

The Iowa Orthopaedic Journal
|August 4, 2020
PubMed

Insights

Surgical rates for pediatric distal radius fractures varied widely across children's hospitals, from 1.45% to 13.8%. Hospital costs also showed significant differences, highlighting the need for further investigation into care variations.

Area of Science:

  • Pediatric Orthopaedics
  • Health Services Research
  • Healthcare Economics

Background:

  • Variations in healthcare delivery can impact patient outcomes and costs.
  • Understanding practice variations is crucial for improving pediatric orthopaedic care.
  • Distal radius fractures (DRFs) in children present an opportunity to study healthcare delivery variations.

Purpose of the Study:

  • To characterize variations in surgical treatment rates for pediatric distal radius fractures.
  • To analyze disparities in hospital costs associated with pediatric distal radius fracture treatment.
  • To utilize the Pediatric Health Information System (PHIS) database for comprehensive analysis.

Main Methods:

  • Data from 2009-2013 were extracted from the PHIS database for pediatric DRFs (ages 4-18).
  • Surgical treatment with internal fixation was identified using CPT and/or ICD-9 procedure codes.
  • Surgical rates and hospital costs were modeled and standardized across 25 children's hospitals.

Main Results:

  • The aggregate surgical rate for pediatric DRFs was 2.65%, with open surgery at 0.81%.
  • Standardized surgical rates varied significantly among hospitals, ranging from 1.45% to 13.8%.
  • Standardized hospital costs per patient ranged from $361 to $1,088, with a relatively uniform distribution.

Conclusions:

  • Significant variability exists in the surgical treatment rates and hospital costs for pediatric distal radius fractures in the US.
  • Further research is needed to identify the root causes of these practice variations.
  • Understanding these variations is essential for improving the value of pediatric orthopaedic care.
Abstract

Keywords:
PHISeconomic decision-makingpediatric distal radius fracturevalue

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