The Burden of Gunshot Injuries on Orthopaedic Healthcare Resources in South Africa
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BACKGROUND: Injuries inflicted by gunshot wounds (GSW) are an immense 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 USD 1,467 per patient. No study has been conducted to estimate the burden of GSWs 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) - an 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 which occurred in the lower extremities. Ninety-five patients received surgical treatment for a total of 135 procedures with a cumulative surgical theatre time of greater than 306 hours. Theatre costs, excluding implants, were in excess of USD 94,490. Eighty of the patients received a total of 99 implants during surgery, which raised theatre costs an additional USD 53,381 cumulatively, or USD 667 per patient. Patients remained in the hospital for an average of 9.75 days, and total costs were USD 130,427 (R1.106 million) for ward admissions, USD 21,583 for imaging, USD 22,563 for blood products, USD 1,914 for laboratory investigations, and USD 1,964 for discharge medication. Individual patient costs range from USD 20,046 to USD 305 for an average of about USD 2,940 (R24,944.68) per patient. CONCLUSION: This study assesses the burden of orthopaedic firearm injuries in South Africa. It estimates that on average treating an orthopaedic GSW patient costs USD 2,940, utilizes just over three hours of theatre time per operation, and necessitates a hospital bed for an average period of 9.75 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.
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