A population-based study of the direct longitudinal healthcare costs of upper extremity trauma in patients aged 18-65 years

Background — Upper extremity (UE) trauma represents a common reason for emergency department visits, but the longitudinal economic burden of this public health issue is unknown. This study assessed the 3-year attributable healthcare use and expenditure after UE trauma requiring acute surgical intervention, with specific focus on injuries that affect function of the hand and wrist.

Methods — We conducted an incidence-based, propensity score–matched cohort study (2006–2014) in Ontario, Canada, using linked administrative healthcare data to identify case patients and matched control patients. We matched adults with hand, wrist and UE nerve trauma requiring surgery 1:4 to control patients. We compared total direct healthcare costs, including 1-year pre-index costs, between case and control patients using a differences-in-difference methodology. The primary outcome was attributable healthcare costs within 3 years of injury.

Results — We matched patients with trauma (n = 26 123) to noninjured patients (n = 104 353). Mean direct healthcare costs attributable to UE trauma were $9210 (95% confidence interval [CI] 8880 to 9550) within 3 years. Patients with trauma had significantly more emergency department visits (≥ 3 visits: 25% v. 12%; p < 0.001), mental health visits (34% v. 28%; p < 0.05) and secondary surgeries (25% v. 5%; p < 0.001). Specific patient populations had significantly greater attributable costs: patients requiring post-traumatic mental health visits ($11 360 v. $7090; p < 0.001), inpatient surgery ($14 060 v. $5940, p < 0.001) and complex injuries ($13 790 v. $7930; p < 0.001).

Interpretation — Healthcare expenditure increased more than fivefold in the year after UE trauma surgery and remained greater than the matched cohort for the subsequent 2 years. Those with more serious injuries and post-injury visits for mental health were associated with higher costs, requiring further study for this public health issue. The mean 1-year pre-injury and 1-year post-injury total costs were $1710 and $9350, respectively.