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Reuse of External Skeletal Fixator Components: Effects on Costs and Complications

Dirschl, Douglas R. MD; Smith, Ilyse J. RN

Journal of Trauma and Acute Care Surgery: May 1998 - Volume 44 - Issue 5 - p 855-858
Article: Presented At The 57Th Annual Meeting Of The American Association For The Surgery Of Trauma And The Japanese Association For Acute Medicine, September 24-27, 1997, Waikoloa, Hawaii

Background Although many community hospitals and trauma centers reuse external fixator components, no published studies have examined the cost-effectiveness or the effect on the rate of complications of reuse. This study reports the preliminary results of a program for the reuse of selected components of external fixators at a trauma center.

Methods After removal from the patient, fixators were cleaned and examined by a single nurse responsible for the program. Components in good repair were returned to the operating room stock for reuse, whereas those showing specific signs of wear were discarded. No component was used more than three times. The medical center charged patients a loaner fee equal to the hospital's cost for reusable components of external fixators. Data were collected for all fixators applied in the 15 months before and after institution of the program (69 and 65 fixators, respectively).

Results The overall mean hospital charge for a fixator decreased 32% as a result of the reuse program (from $4,067 to $2,791). For the two fractures most commonly treated with external fixation, the distal radius and tibial plafond fractures, the mean charge decreased 44 and 29%, respectively. The mean hospital cost for a fixator decreased 34% as a result of the program (from $1,864 to $1,238). There were no differences in the rates of reoperation or complications before and after institution of the reuse program. No patient had mechanical failure of a new or reused fixator body.

Conclusion The preliminary results of this program are encouraging. We recommend that institutions reusing these devices develop specific programs outlining criteria for reuse and guidelines for reprocessing devices for reuse. The results of this study represent an important first step in the validation of the efficacy and safety of reuse of external fixator components.

From the Department of Orthopaedics (D.R.D.), University of North Carolina School of Medicine, Wake Medical Education Institute; and the Wake Medical Center (I.J.S.), Raleigh, North Carolina.

Presented at the Annual Meeting of the Orthopaedic Trauma Association, September 28, 1996, Boston, Massachusetts, and at the Annual Meeting of the American Academy of Orthopaedic Surgeons, February 16, 1997, San Francisco, California.

Address for reprints: Douglas R. Dirschl, MD, Director, Wake AHEC Department of Orthopaedics, University of North Carolina School of Medicine, Wake Medical Education Institute, 3024 New Bern Avenue, Suite 302, Raleigh, NC 27610.

© Williams & Wilkins 1998. All Rights Reserved.