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.
Abstract: Purpose. 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.
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TL;DR: Thursday admission/surgery was associated with longer LOS and day of the week (DOTW) and time of day (TOD) of both admission and surgery did not demonstrate any association with LOS.
Abstract: INTRODUCTION Hospital reimbursements for geriatric hip fractures are contingent on patient outcomes and hospital length of stay (LOS). This study examined if the day of the week (DOTW) and time of day (TOD) of both admission and surgery are associated with increased LOS. METHODS LOS, time from admission to surgery, DOTW of admission/surgery, TOD of admission/surgery, and demographics were retrospectively collected. The average LOS was 4.5 days. Patients were grouped into cohorts of LOS 1 to 4 days (short-stay) and 5 to 12 days (long-stay). The percentage of short-stay patients was compared with the percentage of long-stay patients for each DOTW/TOD of admission/surgery with chi square tests. RESULTS One hundred patients were included, 58 short stays and 42 long stays. Both groups were similar regarding demographics. Long-stay patients were 4.2 times more likely to have been admitted ([95% confidence interval 1.2 to 14.6], P = 0.02) and 4.8 times as likely to have undergone surgery ([95% confidence interval 1.0 to 5.6], P = 0.01) on a Thursday, respectively. TOD of admission/surgery did not demonstrate any association with LOS. DISCUSSION Thursday admission/surgery was associated with longer LOS. Delayed surgical optimization coupled with insurance companies' observance of regular business hours may delay admission to inpatient rehab or skilled nursing facilities, resulting in avoidable healthcare expenditures.
3 citations
01 Sep 2012
TL;DR: An exhaustive algorithm for hip fracture treatment can be implemented and in this case, the algorithm both raised the rate of supervision and reduced the rates of reoperations, the latter saving many hospital bed-days.
Abstract: Introduction We implemented an exhaustive operative and supervision algorithm for surgical treatment of hip fractures primarily based on own previously published literature. The purpose was to improve supervision and reduce the rate of reoperations. Materials and methods 2000 consecutive unselected patients above 50 years admitted with a hip fracture were included, 1000 of these prospectively after implementation of the algorithm. Demographic parameters, hospital treatment and reoperations within the first postoperative year were assessed from patient records. The algorithm dictated the surgical treatment based on three objective patient parameters: age, new mobility score and fracture classification on pre-operative anterior-posterior and axial radiographs. Intra capsular fractures were treated with two parallel implants, a sliding hip screw, an arthroplasty or resection of the femoral head. Extra capsular fractures were treated with a sliding hip screw or an intramedullary nail. Supervision of junior registrars was mandatory for the prosthesis and intramedullary nail procedures. Results 931/1000 operative procedures were operated according to the algorithm, compared to only 726/1000 prior to its introduction (p After implementing the algorithm, junior registrars still performed half of the operations, but unsupervised procedures declined from 192/1000 to 105/1000 (p=0.039). The rate of reoperations declined from 18% to 12% (p Conclusion An exhaustive algorithm for hip fracture treatment can be implemented. In our case, the algorithm both raised the rate of supervision and reduced the rate of reoperations, the latter saving many hospital bed-days.
2 citations
TL;DR: SOI scores may be harnessed as a predictive tool for LOS and total costs following TKA, but other mechanisms are necessary to predict discharge location.
Abstract: Purpose: Total knee arthroplasty (TKA) is increasing in frequency and cost. Optimization of discharge location may reduce total expenditure while maximizing patient outcomes. Although preoperative illness rating systems―including the American Society for Anesthesiologists Physical Classification System (ASA), severity of illness scoring system (SOI), and Mallampati rating scale (MP)―are associated with patient morbidity and mortality, their predictive value for discharge location, length of stay (LOS), and total costs remains unclear.
Materials and Methods: We conducted a retrospective analysis of 677 TKA patients (550 primary and 127 revision) treated at a single institution. The influence of ASA, SOI, and MP scores on discharge locations, LOS, and total costs was assessed using multivariable regression analyses.
Results: None of the systems were significant predictors of discharge location following TKA. SOI scores of major or higher (β=2.08 days, p<0.001) and minor (β=-0.25 days, p=0.009) significantly predicted LOS relative to moderate scores. Total costs were also significantly predicted by SOI scores of major or higher (β=$6,155, p=0.022) and minor (β=-$1,163, p=0.007).
Conclusions: SOI scores may be harnessed as a predictive tool for LOS and total costs following TKA, but other mechanisms are necessary to predict discharge location.
1 citations
Cites background from "Geriatric Hip Fractures and Inpatie..."
...The only significant predictors of discharge to an ECF included AfricanAmerican race (OR, 1.71; p=0.016; 95% CI, 1.10 to 2.64), increasing age (OR, 1.08; p<0.001; 95% CI, 1.05 to 1.10), and increasing BMI (OR, 1.07; p<0.001; 95% CI, 1.03 to 1.10)....
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...Every oneyear increase in age (OR, 1.08; p<0.001; 95% CI, 1.05 to 1.10) and BMI (OR, 1.07; p<0.001; 95% CI, 1.03 to 1.10) increased the risk of ECF discharge....
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...Increasing age has been closely linked to increasing LOS, but BMI has not been previously identified as an independent pre dictive factor20)....
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...The only other significant predictors of LOS included age (β=0.02; p=0.003; 95% CI, 0.01 to 0.03) and BMI (β=0.03; p=0.002; 95% CI, 0.01 to 0.06)....
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...BMI has not been previously identified as a predictor of discharge to ECF....
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References
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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.
1,231 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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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
884 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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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.
600 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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488 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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TL;DR: In this paper, the authors estimate the incidence of surgical-site infection after total hip replacement (THR) and hemiarthroplasty and its strength of association with major risk factors.
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...
453 citations