Predicting the post-operative length of stay for the orthopaedic trauma patient

Chona, Deepak V.; Lakomkin, Nikita; Bulka, Catherine M.; Mousavi, Idine; Kothari, Parth; Dodd, Ashley C.; Shen, Michelle; Obremskey, William T.; Sethi, Manish K.

doi:10.1007/s00264-017-3425-2

Cited by 28 publications

(11 citation statements)

References 25 publications

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“…Age as a risk factor for increased hospital length of stay and complications in geriatric trauma patients has been demonstrated in several studies. 19 This correlation even remains after controlling for patient comorbidities and ISS score. However, the mean/expected length of stay, complications, cost of care for different age groups are not cited in these studies.…”

Section: Discussionmentioning

confidence: 92%

“…However, the mean/expected length of stay, complications, cost of care for different age groups are not cited in these studies. 19 , 20 Furthermore, previous analyses including those from our institution have demonstrated that several injury severity scores including TRISS, ISS, and STTGMA, can predict mortality and length of stay. Of these scores, only STTGMA includes age as a continuous variable.…”

Section: Discussionmentioning

confidence: 93%

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Who Is the Geriatric Trauma Patient? An Analysis of Patient Characteristics, Hospital Quality Measures, and Inpatient Cost

Konda

Lott

Mandel

et al. 2020

Geriatr Orthop Surg Rehabil

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Purpose: The purpose of this study was 2-fold: 1) to investigate the age-related frequency, demographics and distribution of the middle-aged and geriatric orthopedic trauma population and 2) to describe the age-related frequency and distribution of hospital quality measure outcomes and inpatient cost. Methods: All patients > 55 years of age who required orthopedic, trauma, or neurosurgery consults at 3 hospitals within an academic medical center from 2014 to 2017 were prospectively followed. On initial evaluation, each patient’s demographics, injury severity, and functional status were collected. Patients were grouped into low and high-energy mechanism cohorts and divided into 5 groups based on age. Hospital quality measures including length of stay, complications, discharge location, and cost of care was compared between age groups. Data were analyzed using ANOVA and Chi-square tests. Results: A total of 3965 patients were included in this study of which 3268 (82%) sustained low-energy trauma and 697 (18%) sustained high-energy trauma. With increasing age, more patients had more comorbidities, were less likely to be community ambulators, and more likely to use assistive devices (p < 0.05). Patients in older age groups had longer lengths of stay, more complications, were more likely to need ICU level care, and were less likely to be discharged home (p < 0.05). Rates of mortality were also greater in patients of more advanced age in both low and high-energy cohorts, and the calculated risk triage tool (STTGMA) score increased with each age bracket (p < 0.05). Total cost of care differed between age groups in the low-energy cohort (p = 0.003). Conclusion: This epidemiological study provides a clear picture of the frequency and distribution of demographic, physiologic characteristics, outcomes, and cost of care in a middle-aged and geriatric orthopedic trauma population as evaluated by the STTGMA risk tool. Risk profiling of geriatric trauma patients allows for the establishment of baseline norms.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 93%

Who Is the Geriatric Trauma Patient? An Analysis of Patient Characteristics, Hospital Quality Measures, and Inpatient Cost

Konda

Lott

Mandel

et al. 2020

Geriatr Orthop Surg Rehabil

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show abstract

“…2, hinted that some patients had a negative length of stay (meaning the registered discharge date was before the admission date), and some patients apparently had been in treatment for up to 370 days, which seemed implausible. The average length of stay of trauma patients analysed in a publication by Chona et al was 3.8 ± 5.4 days [20]. Since the university hospital in Lübeck treated severely injured and complicated cases, the maximum plausible length of stay was extended to the first visibly aberrant value at 130 days.…”

Section: Resultsmentioning

confidence: 99%

Validating a transnational fracture treatment registry using a standardized method

Frese

Gode

Heinrichs

et al. 2019

BMC Med Res Methodol

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AimSubsequent to a three-month pilot phase, recruiting patients for the newly established BFCC (Baltic Fracture Competence Centre) transnational fracture registry, a validation of the data quality needed to be carried out, applying a standardized method.MethodDuring the literature research, the method of “adaptive monitoring” fulfilled the requirements of the registry and was applied. It consisted of a three-step audit process; firstly, scoring of the overall data quality, followed by source data verification of a sample size, relative to the scoring result, and finally, feedback to the registry on measures to improve data quality. Statistical methods for scoring of data quality and visualisation of discrepancies between registry data and source data were developed and applied.ResultsInitially, the data quality of the registry scored as medium. During source data verification, missing items in the registry, causing medium data quality, turned out to be absent in the source as well. A subsequent adaptation of the score evaluated the registry’s data quality as good. It was suggested to add variables to some items in order to improve the accuracy of the registry.DiscussionThe application of the method of adaptive monitoring has only been published by Jacke et al., with a similar improvement of the scoring result following the audit process. Displaying data from the registry in graphs helped to find missing items and discover issues with data formats. Graphically comparing the degree of agreement between the registry and source data allowed to discover systematic faults.ConclusionsThe method of adaptive monitoring gives a substantiated guideline for systematically evaluating and monitoring a registry’s data quality and is currently second to none. The resulting transparency of the registry’s data quality could be helpful in annual reports, as published by most major registries. As the method has been rarely applied, further successive applications in established registries would be desirable.

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“…This approach is suitable for large data sets, yet somehow questionable due to selection bias from the primary to the secondary database. Partly, a similar approach was used when scoring the data quality of the BFCC registry, when the length of stay was oriented on 49.778 orthopaedic and trauma patients analysed by Chona et al 4 .…”

Section: Discussionmentioning

confidence: 99%

Validating a transnational fracture treatment registry using a standardized method

Frese

Gode

Heinrichs

et al. 2019

Preprint

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Aim Subsequent to a three-month pilot phase, recruiting patients for the newly established BFCC (Baltic Fracture Competence Centre) transnational fracture registry, a validation of the data quality needed to be carried out, applying a standardized method.Method During the literature research, the method of “adaptive monitoring” fulfilled the requirements of the registry and was applied. It consisted of a three-step audit process; firstly, scoring of the overall data quality, followed by source data verification of a sample size, relative to the scoring result, and finally, feedback to the registry on measures to improve data quality. Statistical methods for scoring of data quality and visualisation of discrepancies between registry data and source data were developed and applied.Results Initially, the data quality of the registry scored as medium. During source data verification, missing items in the registry, causing medium data quality, turned out to be absent in the source as well. A subsequent adaptation of the score evaluated the registry’s data quality as good. It was suggested to add variables to some items in order to improve the accuracy of the registry.Discussion The application of the method of adaptive monitoring has only been published by Jacke et al., with a similar improvement of the scoring result following the audit process. Displaying data from the registry in graphs helped to find missing items and discover issues with data formats. Graphically comparing the degree of agreement between the registry and source data allowed to discover systematic faults.Conclusions The method of adaptive monitoring gives a substantiated guideline for systematically evaluating and monitoring a registry’s data quality and is currently second to none. The resulting transparency of the registry’s data quality could be helpful in annual reports, as published by most major registries. As the method has been rarely applied, further successive applications in established registries would be desirable.

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Predicting the post-operative length of stay for the orthopaedic trauma patient

Cited by 28 publications

References 25 publications

Who Is the Geriatric Trauma Patient? An Analysis of Patient Characteristics, Hospital Quality Measures, and Inpatient Cost

Who Is the Geriatric Trauma Patient? An Analysis of Patient Characteristics, Hospital Quality Measures, and Inpatient Cost

Validating a transnational fracture treatment registry using a standardized method

Validating a transnational fracture treatment registry using a standardized method

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