Admitting Service Affects Cost and Length of Stay of Hip Fracture Patients

Abstract

Introduction:The purpose of this study was to analyze the effect of the admitting service on cost of care for hip fracture patients by comparing the cost difference between patients admitted to the medicine service versus those admitted to a surgical service.Methods:A 2-year cohort of patients 55 years or older who were admitted to a single level 1 trauma center with an operative hip fracture were included. Patient demographics, comorbidities, admitting service, complications, and hospital length of stay were recorded for each patient. Cost of hospitalization, discharge disposition, and 30-day readmissions were collected. Patients who were admitted to the medicine service (medicine cohort) were compared to those admitted to a surgery service (surgery cohort). Multivariate regression models controlling for age, Charlson comorbidity index (CCI), and American Society of Anesthesiology (ASA) scores were used to evaluate hospitalization costs with a P value of <.05 as significant.Results:Two hundred twenty-five hip fracture patients were included; 143 (63.6%) patients were admitted to a surgical service, while 82 (36.4%) were admitted to the medicine service. Patients admitted to medicine service had greater CCI and ASA scores, longer lengths of stay, and more complications than those patients admitted to surgery service. Linear regression model controlling for age, CCI, ASA score, and time to surgery demonstrates that patients admitted to a surgical service will have 2.0-day (95% confidence interval [CI]: 0.561-3.503; P = .007) shorter admissions with a US$4215 reduction in cost (95% CI: US$314-US$8116; P = .034) compared to patients admitted to the medicine service.Discussions:In our urban safety net hospital, hip fracture patients admitted to medicine service had longer lengths of stay and higher total hospitalization costs than patients who were admitted to surgery service.Conclusions:This study highlights that the admitting service should be an area of focus for hospitals when developing programs to provide effective and cost-conscious care to hip fracture patients.

Improving outcomes after hip fracture at a safety net hospital with a standardised hip fracture protocol

“…3,4 Without surgery, the reported mortality rate has been shown to increase to 84.4%. 5 Surgical treatment is an expensive endeavor, with Lott et al 6 demonstrating an average cost of approximately $30,000 for operative hip fracture treatment at their urban safety-net hospital. Even with expensive surgery, morbidity in the surviving population is high, with significant loss of function and decreased ability to live independently.…”

Risk Factors Associated With Extended Length of Hospital Stay After Geriatric Hip Fracture

“… 7 , 8 Although implementations such as orthogeriatric comanagement programs have been shown to decrease LOS and lower inpatient hospitalization cost, geriatric hip fractures still continue to be a disproportionately large resource consumer: hip fractures represent only 14% of geriatric fractures, yet they account for approximately 72% of the total costs of care. 9 10 11 12 Garcia et al 9 found the American Society of Anesthesiologist's (ASA) classification, a measure of the sum of a patient's comorbidities, to have the strongest association with increased LOS in this population. Each increase in ASA classification added an extra $9300 to the daily hospital stay.…”

Mepivacaine Spinal Anesthesia Facilitates Shorter Lengths of Stay and Fewer Urinary Complications in Total Hip Arthroplasty Compared to Bupivacaine

“…Focus on preoperative optimization, surgical techniques, and pain control have been integral in improving a patient's LOS. 20,21 However, an additional clinical consideration should be the improvement of perioperative patient care, like neuraxial anesthesia. In our study, patients receiving mepivacaine stayed almost 10 hours less and were 10 times more likely to be discharged home on POD 0 than patients who had bupivacaine.…”