Surgical treatment, complications, reoperations, and healthcare costs among patients with clavicle fracture in England

Abstract

Introduction The clinical and economic burden of clavicle fractures in England is not well documented. This study evaluated rates of surgical treatment, post-surgical complications, reoperations and costs in patients with clavicle fractures using the Clinical Practice Research Datalink (CPRD) database. Methods CPRD data were linked to National Health Service Hospital Episode Statistics data. Patients with a diagnosis of clavicle fracture between 2010–2018 were selected in CPRD (date of fracture = index date). Of those, patients with surgical intervention within 180 days from index fracture were identified. Rates of post-surgical complications (i.e., infection, non-union, and mal-union), reoperations (for device removal or for postoperative complications), post-operative costs and median time to reoperations were evaluated up to 2 years after surgery. Results 21,340 patients with clavicle fractures were identified (mean age 35.0 years(standard deviation (SD): 26.5), 66.7% male). Surgery was performed on 672 patients (3.2% of total cohort) at an average 17.1 (SD: 25.2) days post-fracture. Complications (i.e., infection, non-union, or malunion) affected 8.1% of surgically treated clavicle fracture patients; the rate of infection was 3.5% (95% CI, 1.7%- 5.2%), non-union 4.4% (95% CI, 2.4%-6.5%), and mal-union 0.3% (95% CI, 0%-0.7%). Adjusting for age, gender, comorbidities and time to surgery, the all-cause reoperation rate was 20.2% (13.2%-30.0%) and the adjusted rate of reoperation for implant removal was 17.0% (10.7%-25.9%)—84% of all-cause reoperations were thus performed for implant removal. Median time to implant removal was 254 days. The mean cost of reoperations for all causes was £5,000. The most expensive reoperations were for cases that involved infection (mean £6,156). Conclusions Complication rates following surgical clavicle fracture care averaged 8.1%. However, reoperation rates exceed 20%, the vast majority of reoperations being performed for device removal. Technologies to alleviate secondary device removal surgeries would address a significant clinical unmet need.

Treatment and Outcome of Fracture-Related Infection of the Clavicle

“…Eighteen (2.9%) of these patients were from our hospital, and ten (1.5%) were referred from other hospitals with an infection. The prevalence of infection is in line with a study by Wolf et al who observed an infection rate of 3.1% (21/672) [16], but higher than the 0.4% (1/251) observed by Shen et al [17]. However, neither of these studies used a validated definition to define infection.…”

“…Studies showed that it has a major impact on the patient's quality of life [12] and can increase hospital-related healthcare costs by up to eight times compared to non-infected fractures [13]. Although studies focusing on infection after operatively treated displaced midshaft clavicular fractures are scarce, infection rates ranging between 0.4% and 7.8% have been reported [14][15][16][17]. As scientific data related to the management of FRI after the operative treatment of clavicular fractures is limited, standardized treatment protocols are almost nonexistent.…”

Management of Displaced Midshaft Clavicle Fractures with Figure-of-Eight Bandage: The Impact of Residual Shortening on Shoulder Function

“…However, recent studies reporting higher nonunion rates after nonoperative treatment and an allegedly better clinical outcome after operative treatment, have led to a shift from nonoperative to operative treatment in the last 15–20 years [ 12 , 13 , 14 ]. Surgically treated patients, however, end up having to undergo second surgery for device removal procedures in more than 85% of cases [ 15 ].…”

Clavicle midshaft fractures should not be considered an easy surgery: reduction and prebending

“…The higher rate of implant removal in women may support this hypothesis. The prebending method proposed by the authors may reduce skin irritation from the plates and patient discomfort, potentially reducing the need for implant removal surgeries [8].…”