The Burden of Orthopaedic Gunshot Injuries on Healthcare Resources in South Africa
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BACKGROUND: Injuries inflicted by gunshot wounds (GSW) are an immense financial burden on the South African healthcare system. In 2005, Allard et al. estimated South African state hospitals treat approximately 127,000 firearm victims annually and concluded the cost of treating an abdominal GSW is approximately $1,467 per patient. No study has been conducted to estimate the burden from an orthopaedic perspective. OBJECTIVE: This study sought to estimate the burden and average cost of treating GSW victims requiring orthopaedic interventions in a South African tertiary level hospital. METHODS: This retrospective study surveyed over 1,500 orthopaedic admissions over a 12-month period in 2012 in Cape Town, South Africa at Groote Schuur Hospital (GSH) - a 893-bed university-affiliated state hospital. Chart review subsequently yielded data on, which allowed for cost analysis of, theatre time, number and type of implants, duration of admission, diagnostic-imaging studies performed, blood products used, laboratory studies ordered, and medications administered. RESULTS: A total of 111 patients with an average age of 28 years (range 13-74) were identified. Each patient was hit by an average of 1.69 bullets (range 1-7). These patients sustained a total of 147 fractures. The majority of injuries occurred in the lower extremities with 38.8% of all fractures in femurs, 15.6% in tibias, and 11.6% in fibulas. Ninety-five patients received surgical treatment for a total of 135 procedures with a cumulative surgical time of 220 hours 3 minutes. Cumulative anesthesia time was 306 hours 25 minutes. Theatre costs, excluding implants, were in excess of R800,000 (estimated $94,284). Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional R452,935 ($53,381) cumulatively, or R5,661.70 ($667.26) per patient. Total costs were in excess of R1 million for ward admissions, R180,000 for imaging, R190,000 for blood products, R16,000 for laboratory investigations, and R16,000 for discharge medication. Individual patient costs range from $18,603 to $305 for an average of about R24,834.43 ($2,927) per patient. INTERPRETATION: This study assesses the burden of orthopaedic firearm injuries in South Africa. It estimates that on average treating an orthopaedic GSW patient costs $2,927, utilizes about 3 hours of theatre time per operation, and necessitates a hospital bed for an average period of 10 days. With a greater understanding of not only the high incidence of orthopaedic GSWs treated in a South African tertiary care trauma center but also the costs incurred, the state healthcare system can better prioritize orthopaedic trauma funding and training opportunities while also supporting cost saving measures, including the redirection of financial resources to primary prevention initiatives.