Economics of open tibial fractures: the pivotal role of length-of-stay and infection

In order to define strategies to curb the continuing increase in healthcare costs, we describe the cost breakdown of open tibial fractures. Twenty-seven clinical and process variables were recorded retrospectively, and five main hospital related cost categories were defined. Three multivariate linear models were fitted to the data. Total healthcare costs of open tibial fractures were almost twice as high compared to closed fractures and mainly existed of hospitalization costs. Length-of-stay (LOS) was found to be the most important variable driving the healthcare costs of open tibial fractures. Deep infection lead to a 6-fold increase of LOS and 5-fold increase in total healthcare costs of open tibial fractures. Therefore, appropriate international consensus guidelines are required to improve not only the patient outcome (infection prevention) but also reduce overall healthcare cost by focusing on reducing the LOS.