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


Methods
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.


Results
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).


Conclusions
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.
['Jensen|Courtney D|CD|', 'Stark|Jamie T|JT|', 'Jacobson|Lewis E|LE|', 'Powers|Jan M|JM|', 'Leslie|Kathy L|KL|', 'Kinsella-Shaw|Jeffrey M|JM|', 'Joseph|Michael F|MF|', 'Denegar|Craig R|CR|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D015360:Analgesia, Epidural D000700:Analgesics D005260:Female D017722:Hospital Charges D006801:Humans D008297:Male D008875:Middle Aged D010146:Pain D059408:Pain Management D012189:Retrospective Studies D012253:Rib Fractures D013904:Thoracic Vertebrae D055815:Young Adult
Thoracic Epidural Trauma Analgesic Anesthesiology Pain Management Pain Medicine Regional Pain Treatment Outcome