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

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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 1 st January 2015 to 30 st 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 orthopedic surgery. Conclusion The case volume and mix highlight the growing importance of trauma, fragility fractures and degenerative joint diseases in orthopedic care in developing country set up. Overall, the observed model of care and associated outcome and costs provide a blueprint for orthopedic system development.

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