Hello and welcome back to The Medical Technology Blog, brought to you by Espicom Business Intelligence. In today’s tough economic climate, everybody is looking to save money, one hospital in America has submitted this study, please read on….
Nearly US$30 million a year would be saved in hospital charges if early, rather than delayed, ACL (anterior cruciate ligament) reconstruction surgery was performed on paediatric patients, according to a study conducted at the Children’s Hospital of Philadelphia (CHP) and presented at the American Orthopaedic Society for Sports Medicine‘s (AOSSM) annual meeting in Providence, RI. Additionally, more than 7,300 tears to the meniscus and 7,800 cartilage tears in children could be avoided each year in the US by early ACL surgery, the study authors say. The study revealed that more than US$29.4 million would be saved in hospital charges for pediatric patients each year in the US by reconstructing ACL tears early rather than delaying treatment.
The timing of paediatric and adolescent ACL surgery has historically been controversial, explained Dr Theodore J Ganley, Director of Sports Medicine and Associate Professor at CHP, as the theoretical risks of growth disturbance in younger patients are balanced against the risk of further knee damage related to delaying treatment until closer to skeletal maturity. The goal of ACL knee surgery is to stabilise the knee allowing patients get back to a healthy, active lifestyle. Long-term, the surgery aims to prevent instability and additional damage to the knee.
A 14-year review of ACL reconstructions presented by the authors at the 2009 AOSSM annual meeting revealed a four- to 11-fold increase in meniscal and cartilage injuries with a greater than 12-week delay in ACL treatment. In the current study, a model for paediatric ACL reconstruction was developed based on probabilities derived from the ACL review. Identical groups of 100,000 patients, representative of the US population, were simulated to undergo either early or delayed ACL reconstruction, with the secondary meniscal and cartilage damage and hospital charges compared between the two groups.
The decision tree and statistical modelling approach for the study, created by the study’s co-author Suneel Bhat, is claimed to be “unique” in that it incorporates variability, thereby generating a model simulation of a large scale prospective study, which provides a way to generalise implications, said Ganley. The simulation found that in females in the US, delaying ACL reconstruction beyond 12 weeks resulted in 1,560 medial meniscal tears and 2,100 cartilage tears relative to early surgery each year. In males, delayed surgery resulted in 3,300 medial meniscal tears and 5,720 cartilage tears relative to early surgery.
Apart from the financial benefits to this approach, surely there has to be less discomfort for the patient, that must be factored in as well? I’d certainly like to hear the thoughts of any clinicians reading this post.
In my next post…
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