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.
Highlights
Musculoskeletal injuries have become increasingly more common in the USA, with approximately three out of everyJ Orthopaed Traumatol (2014) 15:255–258 five injuries occurring to this system [1]
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
Our study demonstrates that American Society of Anesthesiologists (ASA) status is a powerful predictor of LOS in patients undergoing operative fixation of ankle fractures
Summary
Musculoskeletal injuries have become increasingly more common in the USA, with approximately three out of everyJ Orthopaed Traumatol (2014) 15:255–258 five injuries occurring to this system [1]. Healthcare costs continue to be a central issue in the US economy, especially with the signing of healthcare reform legislation in 2010 With impending changes such as the transition to a bundled payment system, it is crucial for orthopedic trauma surgeons to develop a better understanding of cost drivers for the treatment of ankle fractures. We sought to identify factors influencing the postoperative LOS in patients with operatively treated ankle fractures. 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. 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
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