ArticleBMJ open2020
The economic burden of infections following intramedullary nailing for a tibial shaft fracture in England.
Article in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 1 of them a synthesis that pooled it.
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Who cites it
23 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- Outcomes of early versus delayed weight-bearing with intramedullary nailing of tibial shaft fractures: a systematic review and meta-analysis.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Pooled it
- Cost analysis of photobiomodulation in tibia fracture in the Brazilian public health system.PloS one · 2023Trial
- Lactic acid bacteria-derived biosurfactants: emerging strategies for biofilm control, virulence attenuation, and food safety.World journal of microbiology & biotechnology · 2026Review
- In Vitro Antibacterial Efficacy of a New TiONanomaterials (Basel, Switzerland) · 2025Article
- The burden of hand trauma surgery on primary care in the United Kingdom: a nation-wide analysis of antibiotic and opioid prescriptions.The Journal of hand surgery, European volume · 2025Article
- Prevalence of infection and associated factors after intramedullary nailing in African countries with the Surgical Implant Generation Network program: A systematic review and meta-analysis of available evidence.SAGE open medicine · 2025Review
- The economic impact of open lower limb fractures in the Netherlands: a cost-of-illness study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
- Biofilm Formation, Antibiotic Resistance, and Infection (BARI): The Triangle of Death.Journal of clinical medicine · 2024Review
- Costs of fracture-related infection: the impact on direct hospital costs and healthcare utilisation.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
- Assessing the effectiveness of intramedullary nailing for tibial shaft fractures in a low-income setting: a prospective study in Yemen.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- A major trauma centre experience with gentamicin-coated tibial intramedullary nails (ETN PROtect™) in acute primary open fracture fixation and complex revision surgery.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Article
- The Impact of Sterile Instrument Set Wrapping Defects on Trauma and Orthopaedic Surgery Theatre Lists.Cureus · 2022Article
- Microbial resistance to nanotechnologies: An important but understudied consideration using antimicrobial nanotechnologies in orthopaedic implants.Bioactive materials · 2022Review
- Patient Comorbidities Associated With Acute Infection After Open Tibial Fractures.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2022Article
- Healthcare resource use and costs related to surgical infections of tibial fractures in a Spanish cohort.PloS one · 2022Article
- Rates and timing of short-term complications following operative treatment of tibial shaft fractures.OTA international : the open access journal of orthopaedic trauma · 2021Article
- Current concepts in the prevention, diagnosis and treatment of fracture-related infection (FRI).European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2021Review
- Strategies to Improve Bone Healing: Innovative Surgical Implants Meet Nano-/Micro-Topography of Bone Scaffolds.Biomedicines · 2021Review
- Bone infections: local delivery of antibiotics and their effectiveness.OTA international : the open access journal of orthopaedic trauma · 2021Article
- Risk factors associated with delayed and aseptic nonunion following tibial diaphyseal fractures managed with intramedullary nailing.Bone & joint open · 2021Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesDetermine the impact of infections on direct costs and healthcare resource use in England for patients undergoing intramedullary nailing (IMN) for tibial shaft fractures.
designNon-concurrent cohort based on retrospectively collected data with 2-year follow-up.
settingEngland.
participantsThe study population included adult patients (≥18 years) in England with a diagnosis of tibial shaft fracture (International Classification of Diseases-10, S822) in the inpatient setting between May 2003 and June 2017 followed by a procedure for IMN for tibial shaft fracture within 30 days. Patient data were derived from the Clinical Practice Research Datalink linked to National Health Service Hospital Episode Statistics datasets. PRIMARY INDEPENDENT VARIABLE: Infection. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was total inpatient costs from index stay admission through 1 year of follow-up. Secondary outcome included cumulative total healthcare costs, and resource utilisation at 30 days, 90 days, 1 year and 2 years.
resultsOverall, 805 patients met the inclusion criteria. At index inpatient stay, 3.7% had a post-IMN infection, rising to 11.7% at 1 year. One-year inpatient costs were 80% higher for patients with infection (p<0.001). Total costs were estimated to be £14 756 (95% CI £13 123 to £16 593) for patients with infection versus £8279 (95% CI £7946 to £8626). Length of stay (LOS), readmission and reoperation were the key drivers of healthcare costs (all p<0.001). After adjustment, LOS was higher by 109% (95% CI 62% to 169%), from 10.5 days to 21.9 days, for patients with infection. The odds of being readmitted or requiring reoperation were higher by 5.18 times (95% CI 3.01 to 9.13) and 2.47 times (95% CI 1.48 to 4.09), respectively, for patients with infection versus those without infection.
conclusionsPost-IMN infection significantly increases inpatient costs, LOS, readmissions and reoperations associated with tibial fracture fixation. Healthcare burden could be reduced through novel surgical site infection prevention strategies.
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