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Journal ArticleDOI

Geriatric Hip Fractures and Inpatient Services: Predicting Hospital Charges Using the ASA Score

30 Apr 2014-Current Gerontology and Geriatrics Research (Hindawi Publishing Corporation)-Vol. 2014, pp 923717-923717

TL;DR: The findings of this study will allow payers to identify the major cost drivers for inpatient services based on a hip fracture patient's preoperative physical status.

AbstractPurpose. To determine if the American Society of Anesthesiologist (ASA) score can be used to predict hospital charges for inpatient services. Materials and Methods. A retrospective chart review was conducted at a level I trauma center on 547 patients over the age of 60 who presented with a hip fracture and required operative fixation. Hospital charges associated with inpatient and postoperative services were organized within six categories of care. Analysis of variance and a linear regression model were performed to compare preoperative ASA scores with charges and inpatient services. Results. Inpatient and postoperative charges and services were significantly associated with patients' ASA scores. Patients with an ASA score of 4 had the highest average inpatient charges of services of $15,555, compared to $10,923 for patients with an ASA score of 2. Patients with an ASA score of 4 had an average of 45.3 hospital services compared to 24.1 for patients with a score of 2. Conclusions. A patient's ASA score is associated with total and specific hospital charges related to inpatient services. The findings of this study will allow payers to identify the major cost drivers for inpatient services based on a hip fracture patient's preoperative physical status.

Topics: Trauma center (54%), Hip fracture (51%)

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Citations
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Journal ArticleDOI
TL;DR: Implementation of a systems-based comanagement strategy using a dedicated team to improve perioperative medical care and expedite preoperative evaluation is cost effective in hospitals with moderate volume and can result in cost savings at higher-volume centers.
Abstract: Background Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program.

82 citations


Journal ArticleDOI

53 citations


Journal ArticleDOI
12 May 2016
TL;DR: The treatment of geriatrics hip fractures in patients with a high ASA score requires a multidisciplinary approach and a special assessment in order to decrease postoperative morbidity and mortality and offer optimal functionality.
Abstract: Hip fractures are the second cause of hospitalization in geriatric patients. The American Society of Anesthesiologists (ASA) classification scheme is a scoring system for the evaluation of the patients' health and comorbidities before an operative procedure. The purpose of this study was to determine whether the ASA score is a predictive factor for perioperative and postoperative complications and a cause of readmission of geriatric patients with hip fractures. The study included 198 elderly patients. The mean values of hospitalization were 6.4 ± 2.1 days for the patients with ASA II, 10.4 ± 3.4 days for the patients with ASA III, and 13.5 ± 4.4 days for the patients with ASA IV. The patients with ASA II exhibited minor complications, while patients with ASA III presented cutaneous ulcer and respiratory dysfunction. Five patients with ASA IV had pulmonary embolism, two patients had myocardial infarction, and three patients died. The ASA score seems to have direct correlation with multiple factors, such as the hospitalization days, the severity of the complications, and the total hospitalization costs. The treatment of geriatrics hip fractures in patients with a high ASA score requires a multidisciplinary approach and a special assessment in order to decrease postoperative morbidity and mortality and offer optimal functionality.

40 citations


Cites background or methods from "Geriatric Hip Fractures and Inpatie..."

  • ...Therefore, surgery and surgical services can be potential areas of improvementwhich can change interrelated higher percentages of postoperative complications and health care costs [10, 13, 20]....

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  • ...This would optimize the relationship between health services and hospitalization costs [13, 20, 23]....

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  • ...TheUS government uses the ASA classification system as a risk-adjustment tool, which identifies the patients’ factors that help predict the hospitalization costs [20, 21]....

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Journal ArticleDOI
TL;DR: A precise cost analysis of the actual hospital costs of hip fractures and to identify patient factors associated with increased costs underlines the necessity of sophisticated risk-adjusted payment models based on specific patient factors.
Abstract: The aim of the present study was to identify patient factors associated with higher costs in hip fracture patients. The mean costs of a prospectively observed sample of 402 patients were 8853 €. The ASA score, Charlson comorbidity index, and fracture location were associated with increased costs. Fractures of the proximal end of the femur (hip fractures) are of increasing incidence due to demographic changes. Relevant co-morbidities often present in these patients cause high complication rates and prolonged hospital stays, thus leading to high costs of acute care. The aim of this study was to perform a precise cost analysis of the actual hospital costs of hip fractures and to identify patient factors associated with increased costs. The basis of this analysis was a prospectively observed single-center trial, which included 402 patients with fractures of the proximal end of the femur. All potential cost factors were recorded as accurately as possible for each of the 402 patients individually, and statistical analysis was performed to identify associations between pre-existing patient factors and acute care costs. The mean total acute care costs per patient were 8853 ± 5676 € with ward costs (5828 ± 4294 €) and costs for surgical treatment (1972 ± 956 €) representing the major cost factors. The ASA score, Charlson comorbidity index, and fracture location were identified as influencing the costs of acute care for hip fracture treatment. Hip fractures are associated with high acute care costs. This study underlines the necessity of sophisticated risk-adjusted payment models based on specific patient factors. Economic aspects should be an integral part of future hip fracture research due to limited health care resources.

13 citations


Cites background from "Geriatric Hip Fractures and Inpatie..."

  • ...Earlier studies have shown that an increased ASA score is associated with increased hospital costs [24, 31]....

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Journal ArticleDOI
TL;DR: It is suggested that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients.
Abstract: Background As procedure rates and expenditures for total hip arthroplasty (THA) rise, hospitals are developing models to predict discharge location, a major determinant of total cost. The predictive value of existing illness rating systems such as the American Society for Anesthesiologists (ASA) Physical Classification System, Severity of Illness (SOI) scoring system, or Mallampati (MP) rating scale on discharge location remains unclear. This study explored the predictive role of ASA, SOI, and MP scores on discharge location, lengths of stay, and total costs for THA patients. Methods A retrospective analysis of patients undergoing elective primary or revision THA was conducted at a single institution. Multivariable regressions were utilized to assess the significant predictive factors for lengths of stay, total costs, and discharge to skilled nursing facilities (SNFs), rehabilitation centers, and home. Controls included demographic factors, insurance coverage, and the type of procedure. Results ASA scores ≥3 are the only significant predictors of discharge to SNFs (odds ratio [OR] = 1.69, confidence interval [CI] = 1.04-2.74) and home (OR = 0.57, CI = 0.34-0.98). Medicaid coverage (OR = 2.61, CI = 1.37-4.96) and African-American race (OR = 2.60, CI = 1.59-4.25) were additional significant predictors of discharge to SNF. SOI scores are the only significant predictors of length of stay (β = 1.36 days, CI = 0.53-2.19) and total cost for an episode (β = $6,234, CI = $3577-$8891). MP scores possess limited predictive power over lengths of stay only. Conclusions These findings suggest that although ASA classifications predict discharge location and SOI scores predict length of stay and total costs, other factors beyond illness rating systems remain stronger predictors of discharge for THA patients.

6 citations


References
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Journal ArticleDOI
08 Dec 2005-BMJ
TL;DR: In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor and lead to increased mortality.
Abstract: Objectives To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality. Design Prospective observational cohort study. Setting University teaching hospital. Participants 2448 consecutive patients admitted with an acute hip fracture over a four year period. We excluded 358 patients: all those aged Interventions Routine care for hip fractures. Main outcome measures Postoperative complications and mortality at 30 days and one year. Results Mortality was 9.6% at 30 days and 33% at one year. The most common postoperative complications were chest infection (9%) and heart failure (5%). In patients who developed postoperative heart failure mortality was 65% at 30 days (hazard ratio 16.1, 95% confidence interval 12.2 to 21.3). Of these patients, 92% were dead by one year (11.3, 9.1 to 14.0). In patients who developed a postoperative chest infection mortality at 30 days was 43% (8.5, 6.6 to 11.1). Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities (2.5, 1.6 to 3.9), respiratory disease (1.8, 1.3 to 2.5), and malignancy (1.5, 1.01 to 2.3). Conclusions In elderly people with hip fracture, the presence of three or more comorbidities is the strongest preoperative risk factor. Chest infection and heart failure are the most common postoperative complications and lead to increased mortality. These groups offer a clear target for specialist medical assessment.

1,098 citations


"Geriatric Hip Fractures and Inpatie..." refers background in this paper

  • ...Similarly, hip fracture patients with a greater number of comorbidities have been shown to be more likely to suffer postoperative complications that would require diagnostics and imaging [25], which would explain the increase in radiology charges with ASA score....

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Journal ArticleDOI
TL;DR: It is concluded that ASA physical status classification was a predictor of postoperative outcome using both univariate analysis and calculation of the odds ratio of the risk of developing a postoperative complication by means of a logistic regression model.
Abstract: In a prospective study of 6301 surgical patients in a university hospital, we examined the strength of association between ASA physical status classification and perioperative risk factors, and postoperative outcome, using both univariate analysis and calculation of the odds ratio of the risk of developing a postoperative complication by means of a logistic regression model. Univariate analysis showed a significant correlation (P

807 citations


"Geriatric Hip Fractures and Inpatie..." refers background in this paper

  • ...The ASA classification system has been shown to be correlated with multiple factors that increase surgical resource utilization including infection [21], reoperations [22], intraoperative blood loss [23], and duration of surgery [24]....

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Journal ArticleDOI

471 citations


"Geriatric Hip Fractures and Inpatie..." refers background in this paper

  • ...The ASA classification system has been shown to be correlated with multiple factors that increase surgical resource utilization including infection [21], reoperations [22], intraoperative blood loss [23], and duration of surgery [24]....

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Journal ArticleDOI
TL;DR: The current knowledge and evaluation regarding ASA Classification of Physical Health as well as trials for possible modification are reviewed.
Abstract: Although the American Society of Anaesthesiologists' (ASA) classification of Physical Health is a widely used grading system for preoperative health of the surgical patients, multiple variations were observed between individual anaesthetist's assessments when describing common clinical problems. This article reviews the current knowledge and evaluation regarding ASA Classification of Physical Health as well as trials for possible modification.

462 citations


"Geriatric Hip Fractures and Inpatie..." refers methods in this paper

  • ...The ASA classification was originally developed for use by anesthesiologists to determine risk of operative morbidity [20] based on patients comorbidities....

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Journal ArticleDOI
Abstract: We wished to estimate the incidence of surgical-site infection (SSI) after total hip replacement (THR) and hemiarthroplasty and its strength of association with major risk factors. The SSI surveillance service prospectively gathered clinical, operative and infection data on inpatients from 102 hospitals in England during a four-year period.The overall incidence of SSI was 2.23% for 16 291 THRs, 4.97% for 5769 hemiarthroplasty procedures, 3.68% for 2550 revision THRs and 7.6% for 198 revision hemiarthroplasties. Staphylococcus aureus was identified in 50% of SSIs; 59% of these isolates were methicillin-resistant (MRSA). In the single variable analysis of THRs, age, female gender, American Society of Anesthesiologists (ASA) score, body mass index, trauma, duration of operation and pre-operative stay were significantly associated with the risk of SSI (p < 0.05). For hemiarthroplasty, the ASA score and age were significant factors. In revision THRs male gender, ASA score, trauma, wound class, duration of oper...

423 citations