Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #74, 10:57 am OTA-2011
Patient Variables That May Predict Length of Stay and Incurred Hospital Costs in Elderly Patients With Low-Energy Hip Fracture
Anna E. Garcia, BS; J. V. Bonnaig, BS; Zachary T. Yoneda, BS; Justin E. Richards, MD;
Jesse M. Ehrenfeld, MD, MPH; Manish K. Sethi, MD; A. Alex Jahangir, MD;
William T. Obremskey, MD, MPH;
Vanderbilt University Medical Center, Nashville, Tennessee, USA
Purpose: Operative fixation of low-energy hip fractures in the elderly is a common orthopaedic procedure that is expected to increase in frequency as the population of older Americans increases. By 2025, incidence and cost of fractures is expected to increase by over 50% as the number of persons over 50 years of age increases by 60% as compared to 2000. In the era of significant healthcare reform aimed at decreasing healthcare costs and transforming reimbursement models, it is critical to identify factors that impact the prognosis and costs of this population. One parameter that can potentially result in increased healthcare costs is increased length of stay during the postoperative period following surgical management of a hip fracture. The purpose of this study is to identify the factors that contribute to increased length of stay after hip fracture surgery, and therefore lead to increased overall costs in the treatment of the elderly hip fracture.
Methods: From January 2000 to December 31, 2009, all patients over the age of 60 yearswho presented to the only Level 1 trauma center in a large metropolitan area with an isolated low-energy hip fracture were reviewed. These patients’ charts were reviewed and information was gleaned including gender, height, weight, body mass index (BMI), length of surgery, length of operative procedure, method of fixation, American Society of Anesthesiologists (ASA) classification, and medical comorbidities. Analysis of the variance was conducted to determine significant trends.
Results: 720 patients were identified, for whom 660 had complete records able to be analyzed. There was no significant correlation between BMI or a specific medical comorbidity and the length of stay. However, ASA classification proved to be a reliable predictor of postoperative length of stay for patients undergoing operative fixation of a hip fracture. For every ASA increase of 1, average subsequent length of hospitalization increases 2.053 days (P <0.001). Utilizing the fact that the average total daily cost to the hospital was determined to be $4530 per day for patients who had fixation of their hip fracture and an uncomplicated postoperative course at our institution, each increase in ASA classification resulted in an increase of $9300 in hospital cost. Thus a patient who is an ASA of 4 will incur on average $27,900 more expense to the hospital than a patient with an ASA of 1 for the fixation of a hip fracture.
Conclusion: This study demonstrates the usefulness of ASA classification in estimating the length of stay for patients undergoing operative fixation of a hip fracture and, subsequently, a predictor of the potential cost to a hospital for treating a patient with a hip fracture. Given that ASA classification and daily cost are universally collected data, this method can easily be employed in almost any hospital system. This study highlights a potential role for the ASA classification in the preoperative estimation of the elderly patient’s cost to a hospital. Furthermore, as reimbursement systems change from a fee-for-service model to a more fixed reimbursement for a specific diagnosis, this study highlights the need for a tiered reimbursement model for each diagnosis based on patient factors.
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• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.