Predictive factors of hospital length of stay in patients with operatively treated ankle fractures

Abstract

BackgroundOperative 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 methodsSix 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.ResultsSix 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.ConclusionsOur 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 EvidenceLevel III retrospective comparative study regressing length of stay with many variables, including ASA physical status.Electronic supplementary materialThe online version of this article (doi:10.1007/s10195-013-0280-9) contains supplementary material, which is available to authorized users.

Economic Burden of Inpatient Admission of Ankle Fractures

“…4,27,38,51 The safety and potential cost savings of outpatient surgery have been reported to extend across foot and ankle surgery as well, including ankle fracture management in particular. 33,53…”

Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues

“…Lastly, McDonald et al 13 retrospectively reviewed 622 patients with ankle fractures from a single institution. In their cohort, more than 40% were aged 50 years, and 38% of patients were ASA class 3 or 4.…”

“…6,12 Although ankle fracture surgery is largely effective and relatively safe, it is nonetheless associated with postoperative morbidity and postdischarge readmissions. 2,11,[13][14][15]17,18 However, the causes for readmission following ankle fracture surgery are poorly understood.…”

Streamlining Hospital Treatment of Prosthetic Joint Infection

“…Cox-regression analysis also identified 2 patient characteristics, ASA score and procedure type, which independently affected LOS. While not specific to PJI, ASA score has been shown to be a powerful predictor of hospital LOS after various orthopedic surgeries [21]. The findings from our analysis showed a 1-unit increase in ASA score was associated with an average decrease of !30% in average daily discharge rate, and thus an increased tendency toward a prolonged hospital course in every category of our analysis.…”