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.
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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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TL;DR: Future estimates of the number of hip fracture will likely fall between the 2 trends described within and by 2050 and may range from 458,000 to 1,037,000 with the largest number occurring in female older than 65 years.
Abstract: BACKGROUND:: Understanding past trends and predicted future incidence of hip fractures is important for the assessment of Medicare sustainability and resource allocation. The purpose of this article was an analysis of most recent data on the incidence of hip fractures to predict the number of hip fractures that will occur in the United States from 2010 to 2050 in individuals 45 and older, by sex, and age distribution. METHOD:: Prior hip fracture data were obtained from the National Hospital Discharge Survey during the period 1996-2006. These data were obtained from the US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Projected population estimates were obtained from the Population Division, US Census Bureau and Statistics, August 14, 2008. We used the past number and incidence of hip fractures extrapolated to population projections to predict the future number of hip fractures to 2050 using Application Software (SAS 9.2; SAS Institute Inc) regression model analysis. RESULTS:: Two trends were identified from past reported rates of hip fractures. Trend 1 assumed a continued very slow decline in the incidence of hip fractures in the future yielding a conservative estimate of 458,000 fractures by 2050. Trend 2 ignored the slight decrease in rate over past years and used a constant rate determined from linear regression providing an estimate as high as 1,037,000 in 2050. The largest number of fractures will occur in females older than 65 years. CONCLUSIONS:: Future estimates of the number of hip fracture will likely fall between the 2 trends described within and by 2050 may range from 458,000 to 1,037,000 with the largest number occurring in female older than 65 years. Language: en
86 citations
"Geriatric Hip Fractures and Inpatie..." refers background in this paper
...With the aging US population, it is estimated that over 458,000 to 1,037,000 hip fracture incidents will occur by the year 2050 [3]....
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TL;DR: The impact of CGA in informing treatment decisions was modest but may be of value when the initial treatment decision is uncertain, and several factors limited the feasibility of a consultation-type geriatric-oncology service to assess older cancer patients.
Abstract: ObjectivesA comprehensive geriatric assessment (CGA) is an objective means of assessing the global health of older patients. While evidence suggesting its promise in improving outcome prediction in the oncology setting is growing, its benefit in guiding treatment decisions remains uncertain. We soug
80 citations
"Geriatric Hip Fractures and Inpatie..." refers background in this paper
...However, CGR is a complex, labor intensive evaluation that may not be feasible for use in all tertiary care centers [15]....
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...While CGR may be a useful assessment of resource utilization in institutions where orthogeriatric specific management is utilized [19], several factors limit its feasibility in the hospitals where standard of care treatment is provided [15]....
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66 citations
TL;DR: Among the patients with cancer, scores on the Activities of Daily Living Scale were a significant predictor of falls and nurses should conduct fall risk assessments with measures of functional status as included in a CGA.
Abstract: This prospective study evaluated components of a comprehensive geriatric assessment (CGA) to identify rates and predictors of falls in older patients. Fall rates and scores on components of the CGA were compared among adults aged 70 or older in three groups: patients with cancer receiving chemotherapy, patients with cancer not receiving chemotherapy, and community-dwelling adults without cancer. Older adults in the chemotherapy group were hypothesized to fall significantly more often than those in the nonchemotherapy group. Among the patients with cancer, scores on the Activities of Daily Living Scale were a significant predictor of falls. The scores were the only domain of the CGA found to be a significant predictor; therefore, more research is needed to better understand fall risk assessment among older patients with cancer. Nurses should conduct fall risk assessments with measures of functional status as included in a CGA.
54 citations
TL;DR: The study findings indicate that the pre-injury ASA-PS scale is a reliable score for classifying comorbidity in trauma patients.
Abstract: Background Pre-injury comorbidities can influence the outcomes of severely injured patients. Pre-injury comorbidity status, graded according to the American Society of Anesthesiologists Physical Status (ASA-PS) classification system, is an independent predictor of survival in trauma patients and is recommended as a comorbidity score in the Utstein Trauma Template for Uniform Reporting of Data. Little is known about the reliability of pre-injury ASA-PS scores. The objective of this study was to examine whether the pre-injury ASA-PS system was a reliable scale for grading comorbidity in trauma patients. Methods Nineteen Norwegian trauma registry coders were invited to participate in a reliability study in which 50 real but anonymised patient medical records were distributed. Reliability was analysed using quadratic weighted kappa ( κ w ) analysis with 95% CI as the primary outcome measure and unweighted kappa ( κ ) analysis, which included unknown values, as a secondary outcome measure. Results Fifteen of the invitees responded to the invitation, and ten participated. We found moderate ( κ w = 0.77 [95% CI: 0.64–0.87]) to substantial ( κ w = 0.95 [95% CI: 0.89–0.99]) rater-against-reference standard reliability using κ w and fair ( κ = 0.46 [95% CI: 0.29–0.64]) to substantial ( κ = 0.83 [95% CI: 0.68–0.94]) reliability using κ . The inter-rater reliability ranged from moderate ( κ w = 0.66 [95% CI: 0.45–0.81]) to substantial ( κ w = 0.96 [95% CI: 0.88–1.00]) for κ w and from slight ( κ = 0.36 [95% CI: 0.21–0.54]) to moderate ( κ = 0.75 [95% CI: 0.62–0.89]) for κ . Conclusions The rater-against-reference standard reliability varied from moderate to substantial for the primary outcome measure and from fair to substantial for the secondary outcome measure. The study findings indicate that the pre-injury ASA-PS scale is a reliable score for classifying comorbidity in trauma patients.
47 citations
"Geriatric Hip Fractures and Inpatie..." refers background in this paper
...reliability has been reported when limited to a single surgical specialty [27, 28]....
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