ABSTRACT
Objectives@#Fragility hip fractures present not only as a significant cause of morbidity and mortality to the elderly population but also as an important source of financial burden due to staggering costs for treatment. This study is designed to determine the effects of timing of hospitalization to the treatment costs of patients with acute fragility hip fractures. @*Methods@#In this retrospective cohort study, the patient database of the University of the Philippines Manila-Philippine General Hospital Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service was reviewed to investigate the effects of timing of hospitalization to the treatment cost of patients with acute fragility hip fractures admitted in a tertiary government hospital. The economic burden of this group of patients was also computed. @*Results@#A total of 118 patients were enrolled in the study with 54 patients in the early hospitalization (EH) group ( 3 days from injury) and 64 in the delayed hospitalization (DH) group (4e28 days). Median treatment cost is less among the EH group than those who were in the DH group (P ¼ 0.0362). The computed economic burden of patients with acute fragility hip fractures is PhP 1,094,048,363.00 (USD 22,595,007.79) per year in the Philippines. @*Conclusions@#Fragility hip fractures impose significant financial impact; and therefore, recommend early hospitalization to lessen treatment cost. Future studies should also be undertaken to investigate other interventions that may help alleviate this burden.
ABSTRACT
Objectives@#Fragility hip fractures present not only as a significant cause of morbidity and mortality to the elderly population but also as an important source of financial burden due to staggering costs for treatment. This study is designed to determine the effects of timing of hospitalization to the treatment costs of patients with acute fragility hip fractures. @*Methods@#In this retrospective cohort study, the patient database of the University of the Philippines Manila-Philippine General Hospital Orthogeriatric Multidisciplinary Fracture Management Model and Fracture Liaison Service was reviewed to investigate the effects of timing of hospitalization to the treatment cost of patients with acute fragility hip fractures admitted in a tertiary government hospital. The economic burden of this group of patients was also computed. @*Results@#A total of 118 patients were enrolled in the study with 54 patients in the early hospitalization (EH) group ( 3 days from injury) and 64 in the delayed hospitalization (DH) group (4e28 days). Median treatment cost is less among the EH group than those who were in the DH group (P ¼ 0.0362). The computed economic burden of patients with acute fragility hip fractures is PhP 1,094,048,363.00 (USD 22,595,007.79) per year in the Philippines. @*Conclusions@#Fragility hip fractures impose significant financial impact; and therefore, recommend early hospitalization to lessen treatment cost. Future studies should also be undertaken to investigate other interventions that may help alleviate this burden.
ABSTRACT
@#<p style="text-align: justify;"><strong>Objective.</strong> The COVID-19 pandemic continues to wreak havoc in all sectors of society one year after it was declared by the World Health Organization. This retrospective study aims to describe the clinical picture, management, and initial outcomes of patients with infected diabetic neuro-ischemic foot ulcerations (NIFU) afflicted with SARS-CoV-2 managed at a government tertiary hospital during the pandemic; and to compare those who survived from those who did not from this combination of diseases.</p><p style="text-align: justify;"><strong>Methods.</strong> Chart review of patients with combined infected diabetic NIFU and COVID-19, admitted at the Philippine General Hospital serving as a COVID-19 referral center, from April 1 to December 31, 2020 was performed. Data collected included patient demographics, clinical presentation including NIFU grade and stage, and severity of COVID-19, coagulation and inflammatory laboratory results, management, and initial outcomes.</p><p style="text-align: justify;"><strong>Results.</strong> A total of 59 patients with diabetic foot ulcer were co-managed by the Department of Orthopedics during this period of the pandemic. Nine of these patients were COVID-19 positive of which six patients did not survive their illness. The non-survivors were slightly older (58.33 vs. 52.67 y/o), had more co-morbidities, and presented with more severe COVID-19 (3 patients had critical COVID-19) than the survivors. All nine patients had deranged coagulation parameters including elevated D-dimer levels, and elevated inflammatory markers (CRP, Ferritin, LDH). Procalcitonin levels were increased in four of the non-survivors, and normal in all three survivors. Seven of the patients had severe (Grade II or III) and infected/ischemic (Stage B or D) NIFUs that required surgery; however, two patients succumbed to their illness prior to any surgery. Four of the six non-survivors died due to acute myocardial infarction.</p><p style="text-align: justify;"><strong>Conclusion.</strong> The presence of NIFU and COVID-19 in a patient generally results in progression to a turbulent hospital course. This is due to the hypercoagulable and hyperinflammatory states that each disease entity produces, which when combined, are exacerbated. Levels of D-dimer and inflammatory markers, especially procalcitonin, may be used as a predictor of poor outcome, even mortality, in this group of patients.</p>