The impact of compartment syndrome on hospital length of stay and charges among adult patients admitted with a fracture of the tibia

Objectives: To compare hospital charges and length of stay in a series of adult patients with isolated, otherwise uncomplicated tibia fractures with and without acute compartment syndrome (ACS). Design: Retrospective case-control study. Setting: Urban Level I trauma center. Patients: Forty-six previously healthy adults with isolated tibia fractures (open or closed), with or without ACS but without other complication, associated injury, or social circumstance that influenced hospital stay or charges. Intervention: Intramedullary nailing in all patients with immediate fasciotomy and delayed fasciotomy closure in the subset of patients who developed ACS. Main Outcome Measure: Hospital length of stay in days and hospital charges. Results: Forty-six otherwise uncomplicated patients with isolated tibial shaft fractures were identified. Twelve fractures were open. ACS occurred in five patients, all with closed fractures. In 41 patients without ACS (12 open fractures, 29 closed fractures), the mean hospital stay was 3.0 days and mean hospital charges were $23,800. The five patients with ACS underwent a mean of 1.6 additional surgeries to treat the fasciotomy wound, were hospitalized for a mean of 9.0 days, and the mean hospital charges were $49,700. These differences were highly significant for hospital stay (P < 0.005) and charges (P < 0.00004). In contrast, there were no differences in length of stay or hospital charges in patients with closed or open fractures, respectively. Conclusion: The cost of ACS is significant, resulting in hospital stays that are increased threefold and hospital charges that are more than doubled in this cohort of patients. The impact of compartment syndrome on these factors was more important than whether the fracture was open or closed. In addition to the obvious benefit to the patient, methods that decrease the incidence of compartment syndrome and need for fasciotomy such as improved diagnosis to prevent unnecessary fasciotomy and methods to reduce intramuscular pressure and avoid fasciotomy in cases of incipient ACS would also be of value in reducing medical costs.