ASA Score Helps Predict Hospital Length of Stay in Orthopaedic Trauma Patients

Maureen Leahy

A chart review of patients undergoing surgical management of orthopaedic trauma injuries finds that American Society of Anesthesiologists (ASA) status is a strong predictor in estimating hospital length of stay. The results are presented in poster P489, “Length of Stay and American Society of Anesthesiologist (ASA) Status in the Orthopaedic Trauma Patient,” on display in Academy Hall B, McCormick Place.

The authors sought to identify factors that contribute to increased length of stay—which can lead to increased hospital costs—following surgical management of fractures. They identified 10,381 patients who had undergone surgical management of a fracture between Jan. 1, 2000 and Dec. 31, 2010, at a Level 1 trauma center, and reviewed the following information on each patient:

gender
length of stay
length of surgical procedure
method of fixation
ASA classification
medical comorbidities

The researchers used ANOVA analysis to determine validity of the ASA status in predicting length of stay trends. Even after accounting for procedure type, age, gender, and comorbid conditions, ASA status was found to be the strongest predictor of postoperative length of stay in all patients. Moreover, each unit increase in ASA class corresponded to an increased hospital stay of
4.6 days (P < 0.001), compared to the average length of stay for a given orthopaedic procedure. That equates to approximately $20,800 in additional hospital costs, based on an average total daily cost of $4,530 for a postsurgical inpatient stay on a surgical ward, the authors noted.

“The results of the study are significant,” said Manish K. Sethi, MD, senior author of the study. “We have found a risk stratification tool and potential way to predict how long patients will stay in the hospital postoperatively based upon their ASA score. Patients with higher ASA scores will have longer postoperative hospital stays.”

Given that ASA classification and postsurgical daily costs are universally collected data, this method of predicting patient length of stay can easily be employed in almost any hospital system and for any surgical service, according to the researchers.

“The implications for orthopaedic surgeons are vast,” said Dr. Sethi. “With the advent of a bundled payment model in orthopaedics, it is important to gain a better understanding of what resources each patient will require.The ASA score potentially offers a very powerful tool in this regard.”

Dr. Sethi’s coauthors include Zachary Yoneda, BA; Amir A. Jahangir, MD; Jesse Ehrenfeld, MD, MPH; Mallory Powell, BA; and William T. Obremskey, MD, MPH.

Disclosures: Dr. Jahangir—Springer; Orthopaedic Trauma Association. Dr. Ehrenfeld— Springer; Lippincott; Oxford University Press. The other authors report no conflicts.

2013 Annual Meeting News
Tuesday through Friday, February 19 – 23, 2013.
http://www.aaos.org/news/acadnews/2013/AAOS5_3_19.asp