Session VIII - General Interest

Sat., 10/12/13 Topics of General Interest, PAPER #86, 12:30 pm OTA 2013

Utilizing the ASA Score as a Predictor of 90-Day Perioperative Readmission in Patients With Isolated Orthopaedic Trauma Injuries

Vasanth Sathiyakumar, BA; Aaron Yengo-Kahn, BS; Harrison F. Kay, BS; R. Adams Cowley; Young M. Lee, BS; Jesse M. Ehrenfeld, MD, MPH; William T. Obremskey, MD, MPH; Manish K. Sethi, MD;
Vanderbilt University, Nashville, Tennessee, USA

Background/Purpose: As the American health-care system moves toward new payment structures that will no longer reimburse hospitals for perioperative readmission, it is critical that the orthopaedic trauma surgeon develop tools to predict the risk of postoperative readmission. While many studies have investigated readmission in the geriatric hip fracture population, very few studies have explored factors influencing postoperative hospital readmission in the orthopaedic trauma population. The American Society of Anesthesiologists (ASA) physical status classification is used worldwide by anesthesia providers as an assessment of the preoperative physical status of patients. This study seeks to explore factors influencing the readmission of patients with orthopaedic trauma injuries and the potential utilization of the ASA score in predicting a patient’s risk of readmission.

Methods: All orthopaedic trauma patients who presented to a large Level I trauma center for operative treatment of their fracture from January 1, 2005 to December 31, 2010 were identified using CPT code searches and the institution’s orthopaedic database. A total of 7338 unique patients were identified. The charts of these patients were reviewed to identify isolated cases in which there was only a single fracture requiring operative fixation with no other organ injury. 2354 patients fit this strict criterion. Of these patients, 1819 had complete readmission information and were included for analysis. The ASA scores of these patients who had isolated orthopaedic injuries were obtained from the institution’s perioperative warehouse. The electronic medical records of these patients were then reviewed for basic demographic information such as age, gender, race, and medical comorbidities (coronary artery disease, diabetes, etc); the date of the first readmission related to the primary orthopaedic trauma fracture; and the reason for readmission. Patients were grouped into the following readmission categories: postoperative infection, postoperative surgical revision, and nonoperative medical condition. A logistic regression controlling for age, gender, race, 21 individual medical comorbidities, and type of fracture was conducted to identify the predictive ability of ASA on the likelihood of readmission for patients with isolated orthopaedic trauma injuries.

Results: Of the 1819 patients with strictly isolated fractures, 216 had acetabular fractures, 1252 had isolated lower extremity fractures, and 351 had isolated upper extremity fractures. After controlling for age, gender, race, medical comorbidities, and type of fracture for these patients, ASA had a significant association with 90-day readmissions (P = 0.036). Compared to patients with an ASA score of 1, patients with an ASA score of 2 were 1.21 times as likely to have a readmission; patients with an ASA score of 3 were 1.46 times as likely to have a readmission; and patients with an ASA score of 4 were 1.77 times as likely to have a readmission.

Conclusion: The ASA score is highly correlated with postoperative readmission rates for patients presenting with isolated orthopaedic trauma fractures. As such, the ASA score could potentially provide a powerful tool to help hospitals target “at risk” individuals in order to reduce the number of 90-day readmissions.

Alphabetical Disclosure Listing

• 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.