1.Hip fractures in the elderly: the impact of comorbid illnesses on hospitalisation costs.
Li-Tat CHEN ; Janise A Y LEE ; Benjamin S Y CHUA ; Tet-Sen HOWE
Annals of the Academy of Medicine, Singapore 2007;36(9):784-787
INTRODUCTIONHip fractures in the elderly are associated with multiple comorbidities.
MATERIALS AND METHODSWe prospectively surveyed and went through all relevant medical records of 70 consecutive patients admitted to Singapore General Hospital following either a cervical or intertrochanteric femoral fracture from late February to May 2004. The total hospitalisation cost for each patient was calculated based on the costs of inpatient care up to the point of discharge. Regression modeling was performed on the 7 commonest age-related conditions (based on our data), to determine the impact of each comorbidity on total costs.
RESULTSThe average age of the cohort was 77.24 years. The median length of stay was 13.6 days. In patients without comorbidities, the mean hospitalisation cost was S$9,347.5 +/- 1719.6. With the presence of comorbidities, the mean cost increased to S$11,502.3 +/- 6024.3. In univariate modeling, dementia added the largest amount to total costs [S$5,398; 95% confidence interval (CI), S$1273 to S$9523; P <0.05]. The presence of diabetes (S$758; 95% CI, S$2,051 to S$3,566), hypertension (S$644; 95% CI, S$1,986 to S$3,274) and osteoarthritis (S$915; 95% CI, S$3,721 to S$1,891) did not significantly add to total costs. When controlled for multiple comorbidities, dementia retained its significance in adding to total costs (S$6,178; 95% CI, S$1,795 to S$10,562; P = 0.006).
CONCLUSION AND DISCUSSIONHip fracture patients with comorbidities incurred higher hospitalisation costs. Cost-containment strategies in hip fracture patients should not only examine the number of comorbidities but also the type of disease.
Aged ; Comorbidity ; Confidence Intervals ; Female ; Follow-Up Studies ; Hip Fractures ; economics ; epidemiology ; Hospital Costs ; statistics & numerical data ; Hospitalization ; economics ; Humans ; Male ; Prospective Studies ; Singapore ; epidemiology
2.Compression Fractures in the Setting of Diffuse Idiopathic Skeletal Hyperostosis.
Amila M G SILVA ; Shron Si Heng TAN ; Milindu Chanaka MAKARANDA ; John Li Tat CHEN
Asian Spine Journal 2015;9(4):629-635
Compression fractures are the most common vertebral fractures. They involve the anterior column of the spine, and are considered stable fractures due to the presence of intact posterior ligaments that aid in resisting further collapse and deformity. They are thus often managed conservatively. We describe a series of 3 cases that were initially diagnosed as compression fractures and managed conservatively. With the abundance of compression fractures and increase in preference for conservative management of compression fractures, it is of utmost importance to recognize the possibility of other spinal co-pathologies, especially that of hyperostosis of the spine, both by clinical judgment as well as radiological analysis before embarking on conservative management, should there be under-treatment and development of complications that could have otherwise been avoided, as in the cases presented in this series.
Congenital Abnormalities
;
Fractures, Compression*
;
Hyperostosis
;
Hyperostosis, Diffuse Idiopathic Skeletal*
;
Judgment
;
Ligaments
;
Radiography
;
Spine
3.The Effect of Body Mass Index on Long-Term Patient-Reported Outcome Scores after Anterior Cervical Discectomy and Fusion in an Asian Population: A 2-Year Study
Shao Jin TEO ; William YEO ; Marcus Zhixing LING ; Poh Ling FONG ; Chang Ming GUO ; John Li Tat CHEN ; Reuben Chee Cheong SOH
Asian Spine Journal 2021;15(4):512-522
Retrospective cohort study. This study aims to analyze the relationship between body mass index (BMI) subjective patient-reported outcomes (PRO) after 1- and 2-level anterior cervical discectomy and fusion (ACDF). The prevalence of cervical spondylosis and ACDF in expected to continue rising among the aging population of Asia. Moreover, the prevalence of obesity is also increasing. However, limited information is available about the mechanism by which BMI affects PRO after ACDF. Total 878 patients underwent ACDF between 2000 and 2015. After excluding patients with previous cervical instrumentation, >2 levels fused, missing BMI measurement, or neoplastic/trauma indication for surgery, 535 patients were included. The PRO measures of the Neck Disability Index, Numerical Pain Rating Scale (NPRS) for Neck Pain, NPRS for Limb Pain, American Academy of Orthopaedic Surgeons–Neurogenic Symptom Score, and Japanese Orthopaedic Association myelopathy score were used. Patients were grouped based on their preoperative BMI, as per the World Health Organization guidelines for Asian populations. PRO scores were collected preoperatively, at 6 months postoperatively, and 2 years postoperatively. A generalized linear model was used to analyze the relationship of BMI category with the individual score, accounting for several factors that are likely to affect the outcomes. Total 19 (3.4%) were underweight, 155 (28.0%) were normal weight, 112 (20.3%) were overweight, and 267 (48.3%) were obese. Patients across all BMI categories experienced significant and similar improvements in their postoperative PRO scores. There were no significant differences in the preoperative, 6-month postoperative, and 2-year postoperative PRO scores of the groups. Rate of reoperation was highest in patients with grade II obesity at 8.07%; however, the difference was not statistically significant. Irrespective of the BMI, all patients exhibited similar satisfactory outcomes following ACDF. The results support surgery in all subgroups of patients with symptomatic nerve compression in the cervical spine.
4.The Effect of Body Mass Index on Long-Term Patient-Reported Outcome Scores after Anterior Cervical Discectomy and Fusion in an Asian Population: A 2-Year Study
Shao Jin TEO ; William YEO ; Marcus Zhixing LING ; Poh Ling FONG ; Chang Ming GUO ; John Li Tat CHEN ; Reuben Chee Cheong SOH
Asian Spine Journal 2021;15(4):512-522
Retrospective cohort study. This study aims to analyze the relationship between body mass index (BMI) subjective patient-reported outcomes (PRO) after 1- and 2-level anterior cervical discectomy and fusion (ACDF). The prevalence of cervical spondylosis and ACDF in expected to continue rising among the aging population of Asia. Moreover, the prevalence of obesity is also increasing. However, limited information is available about the mechanism by which BMI affects PRO after ACDF. Total 878 patients underwent ACDF between 2000 and 2015. After excluding patients with previous cervical instrumentation, >2 levels fused, missing BMI measurement, or neoplastic/trauma indication for surgery, 535 patients were included. The PRO measures of the Neck Disability Index, Numerical Pain Rating Scale (NPRS) for Neck Pain, NPRS for Limb Pain, American Academy of Orthopaedic Surgeons–Neurogenic Symptom Score, and Japanese Orthopaedic Association myelopathy score were used. Patients were grouped based on their preoperative BMI, as per the World Health Organization guidelines for Asian populations. PRO scores were collected preoperatively, at 6 months postoperatively, and 2 years postoperatively. A generalized linear model was used to analyze the relationship of BMI category with the individual score, accounting for several factors that are likely to affect the outcomes. Total 19 (3.4%) were underweight, 155 (28.0%) were normal weight, 112 (20.3%) were overweight, and 267 (48.3%) were obese. Patients across all BMI categories experienced significant and similar improvements in their postoperative PRO scores. There were no significant differences in the preoperative, 6-month postoperative, and 2-year postoperative PRO scores of the groups. Rate of reoperation was highest in patients with grade II obesity at 8.07%; however, the difference was not statistically significant. Irrespective of the BMI, all patients exhibited similar satisfactory outcomes following ACDF. The results support surgery in all subgroups of patients with symptomatic nerve compression in the cervical spine.
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