Epidemiology and medical costs of orthopedic conditions in a tertiary hospital in Kenya; A five-year analysis of admission data.

Abstract

Background: Orthopedic services are a key component of the surgical healthcare system. Scaling up these services would not only reduce the musculoskeletal diseases burden but also the overall disease burden significantly. As such quality intelligence on epidemiology and costs of orthopedic services should be accurately represented for guiding effective policy formulation and implementation. Aim: The aim of the study was to provide a snapshot of the pattern of orthopedic admissions, care and associated medical costs in Kenya. Methods: A retrospective study was conducted reviewing case files of patients admitted to the orthopedic department from 1st January 2015 to 30st November 2019. Results: There were 4320 distinct musculoskeletal admission diagnoses among the 3527 admissions. The study shows that trauma accounts for 53.04% of all admissions while joint replacement, shoulder and knee, limb deformities, infection, removal of hardware, ankle and foot and tumour procedures accounts for 15.01%, 8.87%, 7.29%, 6.44%, 3.94% and 3.23% respectively. Joint replacement is the leading diagnosis among patients in the 61 to 75 years age group and fragility fractures and posttraumatic arthritis featured prominently as the key reasons for joint reconstruction. The proportion of admissions with health insurance (60.82%) was exceptionally high compared to the national average (19.59%). However, current financing mechanism provide inadequate social protection against cost of orthopaedic surgery. Conclusion: The case volume and mix highlight the growing importance of trauma, fragility fractures and degenerative joint diseases in orthopaedic care in developing country set up. Overall, the observed model of care and associated outcome and costs provide a blueprint for orthopaedic system development.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The author(s) received no specific funding for this work. The research study was nested in a quality improvement programme.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The research protocol for this study was reviewed and approved by PCEA Kikuyu Hospital research and ethic committee. The Hospital administration also approved the study including its publication.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

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