Tibial plateau fractures in Belgium: epidemiology, financial burden and costs curbing strategies
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ORIGINAL ARTICLE
Tibial plateau fractures in Belgium: epidemiology, financial burden and costs curbing strategies Michiel Herteleer1,2 · Celien Van Brandt3 · Cindy Vandoren4 · Stefaan Nijs2,3 · Harm Hoekstra2,3 Received: 9 May 2020 / Accepted: 9 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We describe the incidence of tibial plateau fractures and the evolution of its management and financial burden in Belgium, perform a similar audit at University Hospitals Leuven, and define strategies to curb the increasing cost. Methods National data on tibial plateau fractures were collected from the NIHDI and compared to our performance. Several clinical parameters, such as age, sex, treatment modality and length-of-stay, were included. The total healthcare costs are considered as the sum of hospitalization costs and ambulatory care costs. Results Between 2006 and 2018, a total number of 35,226 tibial plateau fractures were diagnosed in Belgium and 861 at our center. The incidence increased 41% over time (mean 25/100,000 persons per year). The mean rate of surgery in Belgium was 37% and slightly decreased over time, due to a larger increase of non-operatively treated tibial plateau fractures. The rate of surgery at the UHL was 49%. Surprisingly, the average cost per patient was equal for operatively and non-operatively treated patients in Belgium, and driven by the length-of stay. Conclusion Since length-of-stay is the main driver of the total healthcare costs of tibial plateau fractures, guidelines on appropriate length-of-stay can help to decrease variability and curb the total healthcare costs, particularly of the non-operatively treated patients. Our performance was in line with this. Level of evidence Level IV. Keywords Knee · Tibial plateau fracture · Economic burden · Length-of-stay Abbreviations TPF Tibial plateau fractures TKA Total knee arthroplasty LOS Length-of-stay UHL University Hospitals Leuven ROS Rate of surgery NIHDI National Institute for Health and Disability Insurance Michiel Herteleer and Celien Van Brandt have contributed equally. * Harm Hoekstra [email protected] 1
Department of Orthopaedics and Traumatology, Unimedizin Mainz, Mainz, Germany
2
Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
3
Department of Trauma Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
4
Management Information and Reporting, University Hospitals Leuven, Leuven, Belgium
Introduction Tibial plateau fractures (TPF) account approximately 1% of all fractures in adults and up to 8% of all fractures in elderly [1, 2]. Wennergren et al. reported in 2018 an increasing incidence of TPF in Sweden with an annual incidence of 26.9 per 100,000 [3]. This increase accounted mainly elderly woman, whereas the incidence of men remained stable. These authors concluded that TPF are most often osteoporosis-related. Although there is often a clear indication for operative management of TPF, the de
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