Tibial Plateau Fractures Complicated by Compartment Syndrome Are Associated With a 3 Times Higher Cost of Care

Abstract

Objectives: To determine the impact of acute compartment syndrome (ACS) and identify cost drivers of 1-year total treatment costs for operative tibial plateau fractures.

Design: Retrospective review.

Setting: Level 1 trauma center.

Patients: 337 patients with tibial plateau fractures, 24 of which were complicated by ACS.

Outcomes: The primary outcome was total treatment cost over the first year for operatively treated tibial plateau fractures. The secondary objective was to use regression analysis to identify significant cost drivers.

Results: The diagnosis of ACS was associated with 2.85 times higher total treatment cost ( P < 0.001). ACS demonstrated increased total treatment cost when controlling for polytrauma ( P < 0.001) and postoperative infection ( P < 0.001). Regression analysis identified 5 variables significantly associated with total cost of care: body mass index, injury severity score, ACS, staged external fixation, and locking fixation ( P < 0.001; R 2 = 0.57). The diagnosis of ACS had the largest impact on total cost with a 3.5× greater impact on cost compared with the next highest variable, staged external fixation.

Conclusions: Tibial plateau fractures complicated by ACS are associated with 2.85 times higher treatment costs over a 1-year period. There were 5 significant variables identified by regression analysis with ACS having the highest impact on total treatment. Together, these 5 factors account for 57% of treatment cost variability.

Level of evidence: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.