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Journal of Orthopaedics and Traumatology

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Open Access 01-12-2014 | Original Article

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

Authors: Matthew R. McDonald, Vasanth Sathiyakumar, Jordan C. Apfeld, Benjamin Hooe, Jesse Ehrenfeld, William T. Obremskey, Manish K. Sethi

Published in: Journal of Orthopaedics and Traumatology | Issue 4/2014

Abstract

Background

Operative 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 methods

Six 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.

Results

Six 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.

Conclusions

Our 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 Evidence

Level III retrospective comparative study regressing length of stay with many variables, including ASA physical status.

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Title: Predictive factors of hospital length of stay in patients with operatively treated ankle fractures
Authors: Matthew R. McDonald
Vasanth Sathiyakumar
Jordan C. Apfeld
Benjamin Hooe
Jesse Ehrenfeld
William T. Obremskey
Manish K. Sethi
Publication date: 01-12-2014
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 4/2014
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-013-0280-9

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Materials and methods

Results

Conclusions

Level of Evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Level of Evidence

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