QIAO Yuanhui, BAI Xiaodong
Objective To analyze the impact of centralized volume-based procurement of trauma orthopedic surgical implants on osteoporotic proximal humerus fracture (OPHF) surgery based on real-world evidence. Methods Key informants were interviewed to collect data on the impact of centralized volume-based procurement of trauma orthopedic surgical implants on OPHF surgery before and after the procurement. An assessment model for OPHF surgery was constructed based on literature reviews and interviews with key informants. Using the implementation of centralized volume-based procurement of trauma orthopedic surgical implants in our hospital in April 2023 as the cutoffpoint, patients with OPHF who visited the Trauma Orthopedics Department and were admitted for open reduction and plate and screw internal fixation surgery from April 2021 to March 2024 were included in the study. Patients from April 2021 to March 2023 were assigned to the control group, while those from April 2023 to March 2024 were assigned to the volume-based procurement study group. Data on surgical time, surgical blood loss, surgical efficiency, hospital stay duration, surgical complications, preoperative and postoperative 1-year upper limb function scores [disabilities of arm, shoulder and hand (DASH), hospitalization costs (implant costs, examination and testing fees, medication costs, treatment and other fees, total hospitalization costs], costeffectiveness ratio (CER), incremental cost-effectiveness ratio (ICER) and surgical satisfaction were collected and analyzed between 2 groups. Results There were no statistically significant differences between the two groups in terms of surgical time, surgical blood loss, intraoperative fluoroscopy frequency, intraoperative adjustment rate of implants, hospital stay duration, surgical complications, examination and testing fees, medication costs, treatment and other fees, preoperative and postoperative DASH scores (P>0.05). Compared with before surgery, the DASH of the two groups were significantly reduced at 1 year postoperatively (P<0.05).Compared with the control group, the study group had significantly lower implant costs, total hospitalization costs and CER (P<0.05). The ICER for both groups was -32.18 thousand yuan/point. Surgical satisfaction was significantly higher in the study group compared to the control group (P<0.05). Conclusion Based on real-world evidence, under the premise of effective quality of diagnosis and treatment, centralized volume-based procurement of trauma orthopedic surgical implants has a significant impact on OPHF surgery, with a marked reduction in patient medical costs and optimization of the overall diagnostic and treatment cost structure.