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ASA classification linked with term of stay, hospital costs for geriatric hip fractures
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SAN ANTONIO — Length of stay and total hospital costs for geriatric patients with low-energy hip fractures increase with higher American Society of Anesthesiologists classification score, according to researchers at Vanderbilt University Medical Center.
“The [American Society of Anesthesiologists] ASA [score] proved to be a reliable predictor of postoperative length of stay for patients undergoing operative fixation for hip fractures,” study investigator Manish K. Sethi, MD, said during his presentation at 2011 Annual Meeting of the Orthopaedic Trauma Association. “It is a good predictor of potential cost. Our results demonstrate the inherent complexities and potential shortfalls of a global payment model, which would not consider patients based on comorbidities.”
The investigators retrospectively studied 660 elderly patients with isolated low-energy hip fractures who underwent open reduction and internal fixation or prosthetic displacement at a single institution from January 2000 to December 31, 2009. Data included comorbidities, body mass index (BMI), ASA classification and length of stay gleaned from electronic and paper medical charts.
The researchers discovered the total average cost for each inpatient at $4,500 — a figure obtained from hospital financial services. They multiplied this cost by length of stay to estimate the cost of postoperative care per patient. The patients had an average BMI of 25 and 7 day average length of stay.
As ASA classification increased, Sethi noted, so did length of stay and total hospital expenses. For each increase in ASA classification of one, the length of stay increased an average of 2 days at a cost of $9,300. For example, a person with an ASA classification of four would cost a hospital $27,900 more than fixation of a fracture for a patient with an ASA classification of one.
“The Academy [of Orthopaedic Surgeons] predicts that hospital admissions for hip fractures will double by 2050,” Sethi said. “So really, what does this mean? Well, if we are dealing with 250,000 cases a year right now in terms of whether they are fixing or replacing, it is going to go up about 500,000 [cases] by 2040. This is going to be a problem for us worldwide.” – by Renee Blisard
Reference:
- Garcia AE, Bonnaig JV, Yoneda ZT, et al. Patient variables that may predict length of stay and incurred hospital costs in elderly patients with low-energy hip fracture. Paper #74. Presented at the 2011 Annual Meeting of the Orthopaedic Trauma Association. Oct. 12-15. San Antonio.
- Manish K. Sethi, MD, can be reached at the Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Ave. S., Suite 4200, MCE-South Tower, Nashville, TN 37232; 615-936-1846; email: manish.k.sethi@vanderbilt.edu.
- Disclosure: Sethi has no relevant financial relationships to disclose.