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Implications of Thoracic Epidural Analgesia on Hospital Charges in Rib Fracture Patients.

Authors
  • Jensen, Courtney D1
  • Stark, Jamie T2
  • Jacobson, Lewis E3
  • Powers, Jan M3
  • Leslie, Kathy L3
  • Kinsella-Shaw, Jeffrey M4
  • Joseph, Michael F5
  • Denegar, Craig R4, 6
  • 1 Department of Health, Exercise, and Sport Sciences, University of the Pacific, Stockton, California.
  • 2 Sum Integral, Chicago, Illinois.
  • 3 St. Vincent Hospital, Indianapolis, Indiana. , (India)
  • 4 Department of Physical Therapy, University of Connecticut, Storrs, Connecticut, USA.
  • 5 Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
  • 6 Department of Kinesiology, University of Connecticut, Storrs, Connecticut, USA.
Type
Published Article
Journal
Pain medicine (Malden, Mass.)
Publication Date
Jan 01, 2018
Volume
19
Issue
1
Pages
160–168
Identifiers
DOI: 10.1093/pm/pnw353
PMID: 28340013
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Rib fractures are present in more than 150,000 patients admitted to US trauma centers each year. Those who fracture two or more ribs are typically treated with oral analgesic drugs and are discharged with few complications. The cost of this care generally reflects its brevity. When a patient fractures three or more ribs, there is an elevated risk of complication. In response, treatments are often broadened and their durations prolonged; this affects cost. While health, function, and survival have been widely explored, patient billing has not. Thus, we evaluated the financial implications of one mode of treatment for patients with rib fractures: thoracic epidural analgesia (TEA). We retrospectively analyzed the registry of a level II trauma center. All patients who fractured one or more ribs (n = 1,344) were considered; 382 of those patients were not candidates for epidural placement and were eliminated from analyses. Epidural placement was determined by individual clinicians. We used multiple linear regressions to determine predictors of cost. After eliminating patients who were not eligible to receive TEA, the average patient bill was $59,123 ($10,631 per day of treatment). The administration of TEA predicted a 25% reduction in total billing (99% CI = -$21,429.55- -$7,794.66) and a 24% reduction in per-day billing (99% CI = -$3,745.99- -$1,276.14). Patients who received TEA were more severely injured and required longer treatments; controlling for these variables, the use of TEA associated with reductions in the cost of receiving care. From an administrative and insurance perspective, more frequent reliance on TEA may be indicated. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected]

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