Dataset Information

Safety and hospital costs of Achilles tendon surgery: the serendipitous impact of a randomized clinical trial.

ABSTRACT:

Background

Surgical management is currently the most common treatment offered for ruptured Achilles tendon; however, the length of hospital stay varies among hospitals. The objective of our study was to compare the costs associated with hospital stay and safety in 2 groups of patients undergoing surgical treatment of Achilles tendon ruptures. The first group of patients represented the surgical arm of a randomized clinical trial, the Multicentre Achilles Tendon Treatment Study (MATTS), and the second group comprised surgically treated patients not included in that trial (non-MATTS).

Methods

We performed an observational analytical retrospective chart review of all patients surgically treated for acute Achilles tendon ruptures at all Calgary-area hospitals over a 3-year period (October 2002-September 2005) who met our inclusion criteria. We determined the costs associated with hospital stay, complications and readmissions for all patients.

Results

A total of 282 patients met our inclusion criteria. Hospital admission costs of patients enrolled in the MATTS trial were less than those of non-MATTS patients treated at each of the 3 Calgary adult hospitals. Non-MATTS patients remained in hospital for 1-4 days in contrast to MATTS patients, who were typically admitted and discharged the day of surgery. The complication rate was similar in both groups (MATTS 9% v. non-MATTS 8%). There were no readmissions in the MATTS group and 2 in the non-MATTS group. Between October 2002 and September 2005, an additional $236,436 was spent on non-MATTS patients who underwent surgery for Achilles tendon rupture.

Conclusion

Acute achilles tendon repair surgery is safe and less costly as an out-patient procedure.

SUBMITTER: Goel DP

PROVIDER: S-EPMC2792381 | biostudies-literature | 2009 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Safety and hospital costs of Achilles tendon surgery: the serendipitous impact of a randomized clinical trial.

Goel Danny P DP Chan Denise D Watson Kathryn K Mohtadi Nicholas N

Canadian journal of surgery. Journal canadien de chirurgie 20091201 6

<h4>Background</h4>Surgical management is currently the most common treatment offered for ruptured Achilles tendon; however, the length of hospital stay varies among hospitals. The objective of our study was to compare the costs associated with hospital stay and safety in 2 groups of patients undergoing surgical treatment of Achilles tendon ruptures. The first group of patients represented the surgical arm of a randomized clinical trial, the Multicentre Achilles Tendon Treatment Study (MATTS), a ...[more]

PMID: 20011182

Similar Datasets

Project description:Background:Functional deficits and health-related impairments are common after an Achilles tendon rupture (ATR). Rehabilitation protocols vary greatly, and few studies have allowed loading in combination with ankle motion immediately after surgery (ie, early functional mobilization [EFM]). It is unclear whether EFM may counteract the negative impact of ankle immobilization after an ATR. Purpose:The primary aim of this study was to assess the efficacy of EFM compared with standard treatment (ie, 2 weeks of unloading in a plaster cast followed by 4 weeks of weightbearing in an orthosis) regarding patient-reported and functional outcomes in patients with an ATR after acute operative repair. The secondary aim was to explore whether the occurrence of deep venous thrombosis (DVT) during the 2 postoperative treatments affected outcomes. Study Design:Randomized controlled trial; Level of evidence, 1. Methods:A total of 135 patients who underwent ATR repair, randomized to either EFM, including immediate postoperative loading and ankle motion, or standard treatment, were evaluated with functional tests and 5 self-administered outcome questionnaires at 6 and 12 months postoperatively. Results:At 6 months, the EFM group scored higher on the RAND 36-Item Health Survey (RAND-36) questionnaire subscales of general health and vitality (P < .05) compared with the control group. No significant differences between the groups were found on disease-specific questionnaires (Achilles tendon Total Rupture Score [ATRS] and Foot and Ankle Outcome Score [FAOS]). At 12 months, no significant differences on any of the patient-reported outcome measures or the functional heel-rise test were seen between the groups. The RAND-36 subscale of general health, however, exhibited higher values in the EFM group (82.6 ± 16.9) than the control group (77.1 ± 17.0) (P = .051) at 12 months after the injury. Patients sustaining DVT postoperatively had lower self-reported outcomes on the ATRS, FAOS, and RAND-36 questionnaires at 6 and 12 months compared with patients not having sustained DVT (all P < .05). Conclusion:This study demonstrated that an accelerated postoperative protocol with immediate loading and ankle motion resulted in better general health and vitality at 6 months. However, there were no differences between the groups in the recovery of heel-rise function. Future studies should focus on the means to reduce the risk of DVT to improve patient outcomes after ATR. Registration:NCT02318472 (ClinicalTrials.gov identifier).

Project description:PurposeFunctional weight-bearing mobilization may improve repair of Achilles tendon rupture (ATR), but the underlying mechanisms and outcome were unknown. We hypothesized that functional weight-bearing mobilization by means of increased metabolism could improve both early and long-term healing.MethodsIn this prospective randomized controlled trial, patients with acute ATR were randomized to either direct post-operative functional weight-bearing mobilization (n = 27) in an orthosis or to non-weight-bearing (n = 29) plaster cast immobilization. During the first two post-operative weeks, 15°-30° of plantar flexion was allowed and encouraged in the functional weight-bearing mobilization group. At 2 weeks, patients in the non-weight-bearing cast immobilization group received a stiff orthosis, while the functional weight-bearing mobilization group continued with increased range of motion. At 6 weeks, all patients discontinued immobilization. At 2 weeks, healing metabolites and markers of procollagen type I (PINP) and III (PIIINP) were examined using microdialysis. At 6 and 12 months, functional outcome using heel-rise test was assessed.ResultsHealing tendons of both groups exhibited increased levels of metabolites glutamate, lactate, pyruvate, and of PIIINP (all p < 0.05). Patients in functional weight-bearing mobilization group demonstrated significantly higher concentrations of glutamate compared to the non-weight-bearing cast immobilization group (p = 0.045).The upregulated glutamate levels were significantly correlated with the concentrations of PINP (r = 0.5, p = 0.002) as well as with improved functional outcome at 6 months (r = 0.4; p = 0.014). Heel-rise tests at 6 and 12 months did not display any differences between the two groups.ConclusionsFunctional weight-bearing mobilization enhanced the early healing response of ATR. In addition, early ankle range of motion was improved without the risk of Achilles tendon elongation and without altering long-term functional outcome. The relationship between functional weight-bearing mobilization-induced upregulation of glutamate and enhanced healing suggests novel opportunities to optimize post-operative rehabilitation.

Dataset Information

Safety and hospital costs of Achilles tendon surgery: the serendipitous impact of a randomized clinical trial.

Background

Methods

Results

Conclusion

Publications

Safety and hospital costs of Achilles tendon surgery: the serendipitous impact of a randomized clinical trial.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets