Faculty Collaboration Database

Predictive factors of hospital length of stay in patients with operatively treated ankle fractures. J Orthop Traumatol 2014 Dec;15(4):255-8

Date

12/18/2013

Pubmed ID

24337780

Pubmed Central ID

PMC4244567

DOI

10.1007/s10195-013-0280-9

Scopus ID

2-s2.0-84912115713 (requires institutional sign-in at Scopus site)   26 Citations

Abstract

BACKGROUND: Operative fixation of ankle fractures is common. However, as reimbursement plans evolve with the potential for bundled payments, it is critical that orthopedic surgeons better understand factors influencing the postoperative length of stay (LOS) in patients undergoing these procedures to negotiate appropriate reimbursement. We sought to identify factors influencing the postoperative LOS in patients with operatively treated ankle fractures.

MATERIALS AND METHODS: Six hundred twenty-two patients with ankle fractures between January 1st, 2004 and December 31st, 2010 were identified retrospectively. Charts were reviewed for gender, length of operative procedure, method of fixation, American Society of Anesthesiologists (ASA) physical status score, medical comorbidities, and postoperative LOS. Both univariate and multivariate models were developed to determine predictors of patient LOS. Financial data for an average 24-h inpatient stay were obtained from financial services.

RESULTS: Six hundred twenty-two patients were included. In a linear regression analysis, a statistically significant relationship was demonstrated between ASA status and LOS (P < 0.001). Multiple regression analysis further characterized the relationship between ASA and LOS: a 1-U increase in ASA classification conferred a 3.42-day increase in LOS on average (P < 0.001). Based on an average per-day inpatient cost of $4,503, each unit increase in ASA status led to a $15,490 increase in cost.

CONCLUSIONS: Our study demonstrates that ASA status is a powerful predictor of LOS in patients undergoing operative fixation of ankle fractures. More complete understanding of these factors will lead to better risk adjustment models for measuring outcomes, determining fair reimbursement, and potential improvements to the efficiency of patient care.

LEVEL OF EVIDENCE: Level III retrospective comparative study regressing length of stay with many variables, including ASA physical status.

Author List

McDonald MR, Sathiyakumar V, Apfeld JC, Hooe B, Ehrenfeld J, Obremskey WT, Sethi MK

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Age Factors
Aged
Ankle Injuries
Cohort Studies
Female
Fracture Fixation, Internal
Fracture Healing
Hospital Costs
Humans
Injury Severity Score
Intra-Articular Fractures
Length of Stay
Linear Models
Male
Middle Aged
Multivariate Analysis
Postoperative Care
Predictive Value of Tests
Prognosis
Radiography
Retrospective Studies
Risk Assessment
Sex Factors
Treatment Outcome
United States
Young Adult