Substantiation of the economic efficiency of the author′s manual repositioning method of the shoulder joint

Abstract

Introduction. Shoulder joint′s dislocation stands first among all dislocations. Assistance to patients with dislocation of the shoulder carries out both outpatient and inpatient. The cost of inpatient treatment is many times higher than that of outpatient care.The aim of the study is to substantiate the economic efficiency of the author′s manual technique for shoulder dislocation repositioning.Materials and methods. The study is longitudinal from 2013 to 2020 inclusive, the sample is continuous, the place of the study is the trauma center of the City Hospital № 1 N. I. Pirogov. Criteria for inclusion of patients in the study — primary dislocation of the shoulder. Diagnosis closed traumatic dislocation of the shoulder in total — 1 968 people. Non-inclusion criteria — secondary dislocation. Successful repositioning of shoulder dislocation on an outpatient basis was performed in 1 159 (58,9 %) patients; after unsuccessful repositioning, 809 (41,1 %) patients were hospitalized with shoulder dislocation. Outpatient patients were randomly divided into 2 groups: group 1 — patients (n=1 552) underwent reduction of the dislocation using traditional methods using local anesthesia, in group 2 patients (n=416) the author′s manual technique was used without local anesthesia. There were no statistically significant differences in gender, age, and type of dislocation in both groups. The effectiveness of using traditional methods with the use of local anesthesia was 52% (dislocation was repositioned in 807 patients), the rest of the patients were treated in an inpatient setting. The use of manual techniques was effective in 84,6 % of cases (352 people), 64 people were hospitalized (15,4 %).Results. Comparison of the cost of treatment was carried out on the basis of the Tariff Agreement in the compulsory medical insurance system of the Sevastopol city dated December 20, 2021: the cost of treating one patient with shoulder dislocation in the traumatology department (13 582,49 rubles) is 13,3 times more than in the trauma center (1 019,5 rub). The effectiveness of the author′s manual technique is 1,63 times higher than the use of standard reduction methods using local anesthesia.Conclusion. The use of the author′s manual technique in patients with shoulder dislocation on an outpatient basis has a higher efficiency compared to traditional methods due to the fact that more patients receive assistance on an outpatient basis, the cost of this service is much cheaper than inpatient treatment. In addition, this type of treatment is carried out without anesthesia, which also reduces the cost of treating of this category of patients.