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Office removal of tibial external fixators: an evaluation of cost savings and patient satisfaction
J D DiCicco1, R F Ostrum, B Martin
1Orthopaedic Trauma and Reconstructive Surgery, Grant Medical Center, Columbus, OH, USA.
Objectives:
To evaluate the efficacy and patient satisfaction of office removal of tibial external fixators and to compare the cost of this procedure with the cost of removal of fixators in the operating room.
Design:
A visual analog scale (VAS) and a questionnaire were answered by all patients after office external fixator removal. The treatment, complications, and costs were compared with those of patients having external fixator removal in the operating suite.
Setting:
An urban orthopaedic trauma office with a Level I trauma center.
Participants:
Two similar groups of patients; thirty fixators removed in the office and twenty-nine fixators removed in the operating room.
Intervention:
Office or operating room removal of tibial external fixators and application of a sterile dressing. A visual analog scale was answered by those patients who had office removal.
Main Outcome Measurements:
Patient satisfaction and pain rating (VAS) with office removal of external fixators. Comparison of costs, infections, time in fixator, and surgical interventions between the office and operating room groups.
Results:
Group I had thirty fixators (twenty-nine half-pin fixators) removed in the office. Group II had twenty-nine fixators removed in the operating room. Duration of time in the frame was not statistically different. Antibiotic usage during the fixator treatment period was 69 percent in both groups. On the visual analog scale, twenty-four members (80 percent) of the office fixator removal group rated the pain during removal as less than 25 percent of maximal, including nine (30 percent) who rated the removal as causing no pain. Cost analysis revealed an average cost of $248 for the office group versus $2,160 for the operating room group (p < 0.001).
Conclusions:
Due to the cost savings and patient satisfaction, without compromising clinical care, the office is our preferred location for tibial half-pin external fixator removal.