Surgical stabilization of rib fractures is associated with better return on investment for a health care institution than nonoperative management

Abstract

Introduction Surgical stabilization of rib fractures(SSRF) continues to gain popularity due to patient benefits. However, little has been produced regarding the economic benefits of SSRF and its impact on hospital metrics such as Vizient. The aim of this study was to explore these benefits hypothesizing SSRF will demonstrate positive return on investment(ROI) for a healthcare institution. Methods This is a retrospective review of all rib fracture patients over 5 years at our Level 1 trauma center. Patients were grouped into SSRF versus nonoperative management(NOM). Basic demographics were obtained including case mix index(CMI). Outcomes included narcotic requirements in morphine milliequivalents(MME) prior to discharge, mortality, and discharge disposition. Furthermore, actual hospital length of stay(ALOS) versus Vizient expected LOS were compared between cohorts. Contribution margin(CM) was also calculated. Independent t-test, paired t-test, and linear regression analysis were performed, and significance set at p < 0.05. Results A total of 1,639 patients were included; 230(14%) underwent SSRF. Age, gender, and Injury Severity Score were similar. SSRF patients had more ribs fractured (7 versus 4; p < 0.001) and more patients with flail chest (43.5% versus 6.7%; p < 0.001). SSRF patients also had a significantly higher CMI (4.33 versus 2.78; p = 0.001). Narcotic requirements and mortality were less in the SSRF cohort; 155 versus 246 MME (p < 0.001) and 1.7% versus 7.1% (p = 0.003), respectively. SSRF patients were more likely to be discharged home (70.4% versus 63.7%; p = 0.006). SSRF patients demonstrated shorter ALOS where NOM patients demonstrated longer ALOS compared to Vizient expected LOS. CMs for SSRF patients were significantly higher and linear regression analysis showed a CM $1,128.14 higher per patient undergoing SSRF (p < 0.001) Conclusion Patients undergoing SSRF demonstrate a significant ROI for a healthcare organization. Despite SSRF patients having a higher CMI, they were able to be discharged sooner than expected by Vizient calculations resulting in better a CM. Level of evidence IV, Therapeutic