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Autograft vs Non-Autograft for Corrective Osteotomy of Forearm Longbones: Analyzing the Impact on Healthcare Utilization
Jason Shrouder-Henry, MD, MBA1; Heather Baltzer, MSc, MD, FRCSC2
1University of Toronto, Toronto, ON, Canada, 2Toronto Western Hospital, Toronto, ON, Canada
Introduction: Grafting, including autograft, allograft or bone substitute is commonly utilized when performing revision surgery for upper extremity fractures. Most studies focus on morbidity associated with autografting, yet little comparison has been performed to examine the impact on healthcare utilization. We hypothesized that use of autografting in corrective osteotomy of the forearm longbones would lead to an increase in healthcare utilization, in areas such as readmission, length of stay and complication rate.
Methods: The NSQIP database for the 2005-2013 years was queried to identify patients who underwent corrective osteotomy of the radius and/or ulna based on Current Procedural Terminology codes. The perioperative surgical data was prospectively collected from American hospitals. 30-day complications, and healthcare utilization outcomes were compared between autograft and non-autograft groups, and included surgical site infection, pneumonia, PE, complication rate, readmission rate, and length of stay. These categorical and continuous variables were compared between groups using Chi square or Fisher’s exact and unpaired T-tests, respectively.
Results: The two groups had similar demographic features and clinical outcomes. 362 patients were identified with 117 and 245 patients in the autograft group and non-autograft group, respectively. There were 5 complications, including 2 superficial and 2 deep surgical site infections, as well as 1 postoperative pneumonia. Overall, the average length of stay was 0.62 days, readmission rate was 2%, and complication rate was 1%. Autografting had no influence on overall 30 day complications or utilization outcomes. For the autograft group, the average length of stay was 0.58 days, readmission rate was 4%, and complication rate was 0.86%. For the non-autograft group, the average length of stay was 0.63 days, readmission rate was 0% and the complication rate was 1.6% (p> 0.05).
Discussion: Healthcare utilization and 30-day complications were low following corrective osteotomy of the forearm longbones. Autograft harvest does not appear to influence healthcare utilization, with respect to readmission, length of stay, and complication rate. Although this procedure has greater morbidity and no difference in utilization, further studies should assess comparative cost-effectiveness of autograft use in corrective osteotomy with a focus on patient outcomes and healthcare economic burden in order to guide clinical management. Given the renewed focus on improving efficiency while maintaining quality we believe that this type of study can provide critical insight into the most relevant cost and quality metrics for this procedure.
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