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: 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.
94 citations
66 citations
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.
50 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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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.
19 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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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.
9 citations
References
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Patent•
15 Nov 1993
TL;DR: In this article, a dual cylindrical chambers mechanically separated, to allow a zone of atmospheric air in between, are used for separating ultra fine particles without stray amounts of oversize with extremely high fine product yields.
Abstract: An air classification system comprises of dual cylindrical chambers mechanically separated, to allow a zone of atmospheric air in between. A primary classification chamber situated vertically below a concentric secondary classification chamber. A rotating parallel blade turbine is situated within the lower primary chamber in order to effect centrifugal particle classification upon a feed material intimately mixed in an air stream. A tubular rotary discharge connected to the turbine which passes through the zone of atmospheric air separating the dual chambers, and extends into the upper secondary chamber which exists to collect and discharge the classified product from the system. A classifier of this design is capable of separating ultra fine particles without stray amounts of oversize with extremely high fine product yields.
152 citations
TL;DR: Perioperative allogeneic transfusion was associated with a higher rate of reoperations for suspected acute infection, however, patients withallogeneic exposure had increased infection risk factors.
Abstract: Background: Patients undergoing total hip or knee arthroplasty frequently receive blood transfusions. The relationship between transfusion and the risk of infection following total joint arthroplasty is unclear. In this study, we sought to examine the impact of allogeneic and autologous transfusion on the risk of acute infection following total hip and total knee arthroplasty.
Methods: We performed a retrospective study of consecutive primary total knee arthroplasties and total hip arthroplasties. Patients who had a reoperation for suspected infection within three months after the arthroplasty were identified. Differences in risk factors were assessed across transfusion groups: no transfusion, autologous only, and allogeneic exposure (allogeneic with or without additional autologous transfusion). Backward-stepwise logistic regression analysis was used to compare reoperations (as outcomes) between cases with and those without allogeneic exposure. Prespecified covariates were body mass index, diabetes, an American Society of Anesthesiologists (ASA) score of >2, preoperative hematocrit, and total number of units transfused perioperatively.
Results: We identified 3352 patients treated with a total hip or knee arthroplasty (1730 total knee arthroplasties and 1622 total hip arthroplasties) for inclusion in the study. Transfusion was given in 1746 cases: 836 of them had allogeneic exposure, and 910 had autologous-only transfusion. There were thirty-two reoperations (0.95%) for suspected infection. Between-group risk-factor differences were observed. The mean age and the rates of diabetes, immunosuppression, ASA scores of >2, and bilateral surgery were highest in the allogeneic group, as were estimated blood loss, surgery duration, and total number of units transfused (p 2 (p = 0.008)—but not allogeneic exposure—were significantly predictive of a reoperation.
Conclusions: Perioperative allogeneic transfusion was associated with a higher rate of reoperations for suspected acute infection. However, patients with allogeneic exposure had increased infection risk factors. After adjustment for the total number of units transfused and an ASA score of >2, allogeneic exposure was not significantly predictive of a reoperation for infection.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
132 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 ASA class is strongly associated with medical problems in the perioperative period following hip fracture surgery in the elderly and patients identified as being at higher risk (in ASA class 3 or 4) preoperatively should be closely managed medically.
Abstract: Background: Comorbidities before and complications following hip fracture surgery can impact the return of function. We hypothesized that the American Society of Anesthesiologists (ASA) classification of medical comorbidities is a useful surrogate variable for the patient's general medical condition and would be a strong predictor of perioperative medical complications following hip fracture surgery.
Methods: A retrospective review of the cases of 197 elderly patients who had undergone operative management of a hip fracture was performed. The ASA class, data regarding perioperative medical and surgical complications, and demographic data were obtained. Medical complications were defined as those requiring intervention by an internist or medical specialist. Differences in complication rates among the ASA classes were determined.
Results: Medical complications were more common in patients in ASA class 3 (p < 0.001) and those in class 4 (p = 0.001) than in those in class 2. Patients in ASA class 3 had a 3.78 times greater chance of having a medical complication than did those in class 2 (p < 0.001). Patients in ASA class 4 had a 7.39 times greater chance of having medical complications than did those in class 2 (p = 0.001). No significant relationship was identified between the ASA class and surgical complications.
Conclusions: The ASA class is strongly associated with medical problems in the perioperative period following hip fracture surgery in the elderly. Patients identified as being at higher risk (in ASA class 3 or 4) preoperatively should be closely managed medically so that perioperative medical complications can be managed and evolving medical issues can be addressed in a timely fashion.
Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.
116 citations
"Geriatric Hip Fractures and Inpatie..." refers background or methods in this paper
...recently showed that ASA classification is strongly associated with medical complications that require interventions by a medical specialist or internist after hip fracture surgery [11]....
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...The ASA scoring system has been proven to be a reliable method for predicting LOS and costs associated with geriatric hip fracture patients [6, 11]....
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TL;DR: More work is needed to understand the complex nature of adverse events in older inpatients, and to tailor safety measurement and improvement strategies to address challenges presented by the complexity of the geriatric syndromes and the processes of care encountered by older inPatients.
Abstract: Purpose Large international studies have shown that older hospital inpatients are at particular risk of adverse events. The purpose of this review was to synthesize data from studies designed to assess the scale and nature of this harm, with the ultimate aim of informing the development of new safety and quality measurement tools to facilitate improved hospital care for these vulnerable patients.
Data sources, study selection and data extraction A systematic search using Ovid SP and other sources was carried out, rigorous inclusion and exclusion criteria were applied and quality assessment of included studies was conducted. Data were synthesized to give a picture of the incidence, types, causes, preventability and outcomes of adverse events in older medical inpatients.
Results of data synthesis Nine relevant studies were identified. A wide range of adverse event incidences were reported, from 5.29 to 6.2% in re-analyses of large adverse event studies, to 60% in studies in which the development of ‘geriatric syndromes’ (e.g. falls, delirium, incontinence) was also considered to be adverse events. Important causative factors other than age included clinical complexity, co-morbidity, illness severity, reduced functional ability and lower quality of care. Adverse events in older people lead to unnecessary interventions with resultant complications and increased length of stay.
Conclusion More work is needed to understand the complex nature of adverse events in older inpatients. We must tailor safety measurement and improvement strategies to address challenges presented by the complexity of the geriatric syndromes and the processes of care encountered by older inpatients.
105 citations
TL;DR: ASA classification proved useful in estimating LOS and cost for patients undergoing operative fixation of hip fractures, highlighting a role for ASA classification in preoperative estimation of the elderly patient's cost and a potential advantage for incorporating patient factors in the development of tiered reimbursement models.
Abstract: Objectives:To investigate what factors contribute to increased length of stay (LOS) and increased costs in treatment of elderly patients with hip fractures.Design:Retrospective chart review.Setting:All patients who presented to a large tertiary care center between January 2000 and December 31, 2009.
89 citations
"Geriatric Hip Fractures and Inpatie..." refers background or methods in this paper
...recently demonstrated that a patient’s ASA score was a stronger predictor of increased LOS and room and board charges than other well-known predictors of costs such as age, BMI, and comorbidities [6]....
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...recently reported that ASA score was associated with increased LOS which correlated to increased room and board charges at a charge of $4503 per day of hospitalization [6]....
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...The ASA scoring system has been proven to be a reliable method for predicting LOS and costs associated with geriatric hip fracture patients [6, 11]....
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