Cost analysis of fracture of the neck of femur.

A detailed cost analysis of fractures of the neck of femur in elderly patients has been conducted at Aberdeen Royal Infirmary. The aims of this study were as follows: (1) to show that the use of average orthopaedic bed day costs can lead to an overestimation of costs; (2) to identify the key explanatory variables of hip fracture costs; and (3) to identify differences in resource consumption between patient groups. The care of 50 first and ten second (contralateral) hip fracture patients admitted to Aberdeen Royal Infirmary in 1993 was costed in considerable detail. Acute care, convalescence, rehabilitation and operations accounted for more than 90% of total costs in both groups. It was found that patients who were admitted from their own homes cost significantly more than patients who were admitted from long-term care (4018 pounds vs. 2069 pounds; p < 0.001). In order to validate the costed samples, additional data were collected on all hip fracture patients admitted to Aberdeen Royal Infirmary in 1993. The main factors in explaining cost variation were the number of days spent in acute care and convalescence or rehabilitation [r2 = 0.62; logcost = (0.009 x acute days) + (0.01 x rehabilitation days) + 3.213]. Age and place of residence prior to admission explained a further 2.8% of total costs but neither variable was statistically significant. When costing fractures of the neck of femur, we recommend the collection of a minimum data set of these four variables which account for 65% of the variation in total costs.