| Summary: | <p><strong>Aims</strong>: An investigation of the impact of a multidisciplinary bone infection unit (BIU) undertaking osteomyelitis surgery with a single-stage protocol on clinical
outcomes and healthcare utilisation compared to national outcomes in
England. <strong>Patients and Methods</strong>: A tertiary referral multidisciplinary BIU was compared to the rest of
England (ROE) and a subset of the 10 next busiest centres based on osteomyelitis treatment episode volume (Top Ten), using the Hospital
Episodes Statistics database (HES). A total of 25 006 patients undergoing
osteomyelitis surgery between April 2013 and March 2017 were included. Data
on secondary healthcare resource utilisation and clinical indicators were
extracted for 24 months before and after surgery. <strong>Results</strong>:
Patients treated at the BIU had higher orthopaedic healthcare utilisation in
the 2 years prior to their index procedure, with more admissions (<span class="inline-formula"><i>p</i><</span> 0.001) and a mean length of stay (LOS) over 4 times longer than other groups (10.99 d, compared to 2.79 d for Top Ten and 2.46 d
for the ROE, <span class="inline-formula"><i>p</i><</span> 0.001). During the index inpatient period, the BIU had fewer mean theatre visits (1.25) compared to the TT (1.98, <span class="inline-formula"><i>p</i><</span> 0.001) and the ROE (1.64, <span class="inline-formula"><i>p</i>=</span> 0.001). The index inpatient period was shorter in the BIU (11.84 d), 33.6 %
less than the Top Ten (17.83 d, <span class="inline-formula"><i>p</i><</span> 0.001) and 29.9 % shorter
than the ROE (16.88 d, <span class="inline-formula"><i>p</i><</span> 0.001). During follow-up, BIU patients underwent fewer osteomyelitis-related reoperations than Top Ten centres (<span class="inline-formula"><i>p</i>=</span> 0.0139) and the ROE (<span class="inline-formula"><i>p</i>=</span> 0.0137). Mortality was lower (4.71 %) compared to the Top Ten (20.06 %, <span class="inline-formula"><i>p</i><</span> 0.001) and the ROE (22.63 %, <span class="inline-formula"><i>p</i><</span> 0.001). The cumulative BIU total amputation rate was lower (6.47 %) compared to the Top Ten (15.96 %, <span class="inline-formula"><i>p</i><</span> 0.001) and the ROE (12.71 %, <span class="inline-formula"><i>p</i><</span> 0.001). Overall healthcare
utilisation was lower in the BIU for all inpatient admissions, LOS, and
Accident and Emergency (A&E) attendances. <strong>Conclusion</strong>: The benefits of managing osteomyelitis in a multi-disciplinary team (MDT) specialist setting included reduced hospital stays, lower reoperation rates
for infection recurrence, improved survival, lower amputation rates, and
lower overall healthcare utilisation. These results support the
establishment of centrally funded multidisciplinary bone infection units that will improve patient outcomes and reduce healthcare utilisation.</p>
|
|---|