Cost analysis and outcomes of simple elbow dislocations

Table 1 Costs of treatment, investigations and support services

Category	Item	Cost (£)
Hospital Services	A and E attendance leading to admission	95
	A and E attendance not leading to admission	76
	Minor Injuries leading to admission	34
	Minor Injuries not leading to admission	42
	Walk in centre leading to admission	31
	Walk in centre not leading to admission	34
	Theatre session (including recovery)	880
Hospitalisation/day	Acute Care Adult wards admission per day	269
Follow-up	Outpatient clinic (new)	116
	Outpatient clinic (follow-up)	93
Support Services	Physiotherapy/session in clinic	34
Radiology	X-ray	59.5
	Computed tomography scan	225
	Magnetic resonance imagingscan	280
	Radiographer per twenty minutes clinic visit (includes A and E)	13

Table 2 Demographic details of patients in each group

	Group I	Group II	Group III
No. of patients	26	27	14
Age (yr)	34.80 ± 15.04	41.36 ± 17.84	35.41 ± 12.23
	Median: 30	Median: 37	Median: 37
Male/female	18/8	17/10	8/6
Right/left	12/14	9/18	7/7
No. of patients admitted	5 (19%)	3 (11%)	3 (21%)
LOS (h)	29.59 ± 19.41	37.42 ± 36.28	33.07 ± 15.03
	Range: 19-68	Range: 15-79	Range: 17-46
Patients referred to physiotherapy	21	20	11
Patients seen by physiotherapy	14	17	5
No. of physiotherapy sessions	2.43 ± 0.76	2.76 ± 1.60	2.60 ± 1.34
	Median: 2	Median: 2	Median: 2
No. of clinic appointments	3.31 ± 1.72	3.15 ± 1.10	3.21 ± 1.48
	Median: 3	Median: 3	Median: 3
Time of follow-up (d)	59.00 ± 38.75	67.32 ± 62.62	81.66 ± 58.80
	Median: 53	Median: 58	Median: 62
Time to mobilisation (d)	5.82 ± 3.57	16.69 ± 4.32	24.37 ± 8.97
	Median: 6	Median: 16	Median: 23
Good outcome	21 patients	23 patients	6 patients

Admitted: Patients had an overnight stay in hospital. LOS: Length of stay; Follow-up: From time of injury to time of discharge or referral to upper limb specialist.

Table 3 Comparisons of the three groups

Variable	Group I vs Group II		Group I vs Group III		Group IIvs Group III		Test
	P	95%CI	P	95%CI	P	95%CI
Gender	0.630	0-3.841	0.6771	0-3.841	0.717	0-3.841	χ2 test
Age	0.155	-15.66-2.56	0.898	-10.09-8.88	0.271	-4.83-16.73	t-test
Side	0.340	0-3.841	0.816	0-3.841	0.300	0-3.841	χ2 test
Admission	0.6591	0-3.841	0.8681	0-3.841	0.6741	0-3.841	χ2 test
Follow-up	0.541	-37.69-20.02	0.143	-54.32-8.17	0.485	-55.13-26.65	t-test
Outcome	0.669	0-3.841	0.0371	0-3.841	0.0141	0-3.841	χ2 test
Medical Costs	0.200	-98.62-460.17	0.401	-215.08-526.57	0.884	-368.78-318.72	t-test

¹Yates’ correction was employed. The results in bold indicate statistical significance (level of 0.05). LOI: Length of immobilisation.

Table 4 Cost analysis per patient

	Group I	Group II	Group III
No. of X-rays	8.38 ± 4.57	6.48 ± 2.53	7.93 ± 4.58
	Median: 7	Median: 6	Median: 7
CT scans	2 patients	1 patient	1 patient
MRI scans	1 patient	-	-
Need for theatre reduction	2 patients	2 patients	-

CT: Computed tomography; MRI: Magnetic resonance imaging.

Table 5 Costs of treatment (£) analysis per patient

Treatment description	Group I	Group II	Group III
Hospital1	219.77 ± 318.27	197.62 ± 398.65	174.79 ± 204.79
	Median: 76.00	Median: 76.00	Median: 76.00
Radiology	590.12 ± 334.96	424.96 ± 156.73	539.36 ± 350.21
	Median: 528.00	Median: 396.00	Median: 429.00
Outpatients	330.62 ± 158.96	315.78 ± 102.21	321.93 ± 137.35
	Median: 302.00	Median: 302.00	Median: 203.00
Physiotherapy	44.46 ± 44.98	59.19 ± 62.97	31.57 ± 8.97
	Median: 68.00	Median: 68.00	Median: 0
Total cost of treatment	1184.96 ± 534.82	1004.19 ± 477.67	1067.64 ± 641.91
	Median: 1166.50	Median: 867.00	Median: 842.00

¹Hospital costs include emergency department’s costs, admission costs and theatre costs. Any further costs after the patient’s referral to an upper limb specialist were not included in the cost analysis.