Geriatric Hip Fractures and Inpatient Services: Predicting Hospital Charges Using the ASA Score

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.

Is the ASA Score in Geriatric Hip Fractures a Predictive Factor for Complications and Readmission?

“…This leads to an increase in the percentage of geriatric hip fractures and subsequently an increase in the growth of health care costs. Moreover, the total cost is burdened with other factors, such as longer recovery periods, postoperative complications and comorbidities, and prolonged hospital stay [ 17 – 20 ].…”

“…Based on the abovementioned information, the need for a risk-adjusted reimbursement system arises. The US government uses the ASA classification system as a risk-adjustment tool, which identifies the patients' factors that help predict the hospitalization costs [ 20 , 21 ]. In addition, apart from the cost-morbidity correlation, the overall patients' health status and their postoperative condition constitute important factors.…”

“…At the same time, the direct proportional relationship between the ASA score and the total hospitalization duration (greater ASA score results in longer hospitalization) demonstrates the need for an algorithmic reimbursement model based on the ASA score. This would optimize the relationship between health services and hospitalization costs [ 13 , 20 , 23 ].…”

“…The intraoperative costs can be further increased if one considers the greater blood loss, the surgery duration, and other factors which are proportionally dependent on the patients' health status. Therefore, surgery and surgical services can be potential areas of improvement which can change interrelated higher percentages of postoperative complications and health care costs [ 10 , 13 , 20 ]. Also, in geriatric hip fractures the multidisciplinary approach and treatment, the early investigation of high risk patients, and the daily individualized care resulted in fewer postoperative complications and transfers to other units, better ambulatory status, and decreased length of stay [ 4 , 19 , 28 , 29 ].…”

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis

“…Highquality economic studies have evaluated the benefits of directing resources toward the focused goal of reducing time to the operating room [19] and the benefits of early initiation of osteoporosis treatment [31,32,35]. Additionally, numerous studies have identified important predictors of perioperative complications, costs, and mortality [5,13,18,41,46,49,53,54,65], suggesting that different patient populations may have different predisposing risk factors, and thus experience different degrees of benefit from a comanagement system. Although the financial issues associated with comanagement programs have been explored [14,19,37], to our knowledge no formal economic analysis based on decision analysis principles-which can be used to synthesize results over multiple studies and create generalizable conclusions-has been performed.…”